KR20210072151A - Neuroactive 19-alkoxy-17-substituted steroids, prodrugs thereof, and methods of treatment using same - Google Patents

Abstract

The present disclosure generally relates to neuroactive 19-alkoxy-17-substituted steroids as referred to herein for use, for example, as anesthetics and/or in the treatment of disorders related to GABA function and activity, and pharmaceutically acceptable thereof. It is about the salt that becomes. The present disclosure further relates to pharmaceutical compositions comprising such compounds.

Description

Neuroactive 19-alkoxy-17-substituted steroids, prodrugs thereof, and methods of treatment using the same {NEUROACTIVE 19-ALKOXY-17-SUBSTITUTED STEROIDS, PRODRUGS THEREOF, AND METHODS OF TREATMENT USING SAME}

government support

The claimed subject was developed with government support under NIH Approval #GM47969 awarded by the National Institutes of Health. Accordingly, the government has certain rights in the subject matter claimed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent Application Serial No. 61/738,822, filed on December 18, 2012, the entire contents of which are incorporated herein by reference.

Background of the disclosure

The present disclosure relates generally to novel compounds having utility as anesthetics and/or in the treatment of disorders related to GABA function and activity. More specifically, the present disclosure relates to steroids having 19-alkoxy-17-substituted tetracyclic structures that are neuroactive and suitable for use as anesthetics, as well as pharmaceutically acceptable salts and prodrugs thereof, and pharmaceuticals containing them. to the composition.

Gamma-aminobutyric acid (GABA) is a major inhibitory neurotransmitter in the central nervous system. GABA activates two types of receptors, contractile GABA _A and metabolic GABA _B receptors. _{Activation of GABA B} receptors by GABA leads to hyperpolarization and consequent inhibition of neurotransmitter release. The GABA _A receptor subtype modulates neuronal excitability and rapid mood changes such as anxiety, panic, and stress responses. GABA _A receptors are chloride ion channels; As a result, activation of the receptor induces increased internal chloride ion flux, resulting in membrane hyperpolarization and neuronal inhibition. Drugs that stimulate GABA _A receptors, such as benzodiazepines and barbiturates, have anticonvulsant effects (by reducing neuronal excitability and raising seizure threshold), as well as anxiolytic and anesthetic effects.

The effects of certain steroids on GABA _{A receptors are well established.} As a result, researchers have continued to pursue the discovery and synthesis of neuroactive steroids that may act as anesthetics and/or may serve to provide treatment for disorders related to GABA function. For example, the current intravenous anesthetic agent alfaxalone (Compound A below) has been shown to induce general anesthesia in humans because it allosterically increases the chloride current mediated by GABA, which acts on GABA _{A receptors in the brain.} Widely accepted However, the various structural features that enable this compound to function in this way are not fully understood to date. For example, in contrast to alfaxalone, Δ ¹⁶ -alfaxalone (Compound B below) has _{been observed to significantly reduce allosteric activity at the GABA A} receptor and is not used as an intravenous general anesthetic in humans.

The difference in the performance of these two compounds, in part due to the presence of a carbon-carbon double bond in the D-ring, has attracted the attention of many researchers. Indeed, it was recently determined that the effect this double bond has on anesthetic activity may depend on the group attached to C-17 on the D-ring. (Bandyopadhyaya, AK, et al., "Neurosteroid analogues. 15. A comparative study of the anesthetic and GABAergic actions of alphaxalone, Δ ¹⁶ -alphaxalone and their corresponding 17-carbonitrile analogues. Bioorg. Med. Chem. Lett., 20: 6680-4 (2010)].

In addition to their anesthetic properties, neuroactive steroids can be used to treat disorders related to GABA function. For example, neuroactive steroids, such as progesterone, exhibit benzodiazepine-like actions and can be used as sedative-hypnotic agents that induce decreased sleep latency and increased non-REM sleep with only small changes in slow wave and REM sleep. In addition, drugs that enhance the GABA response are often used to treat anxiety in humans. Therefore, GABA-enhanced steroids can be expected to exhibit an anxiolytic effect. Given that the accumulated evidence suggests that patients with major depression have reduced GABAergic neurosteroid levels, and that certain treatments for depression alter the levels of these steroids, neuroactive steroids may also be used to treat depression. have. Although GABA is not typically thought to play an important role in the biology of depression, there is evidence that low GABAergic activity may lead to mood disorders. Finally, inhibition of NMDA receptors and enhancement of GABAA receptors appear to play an important role in mediating the acute effects of ethanol in the nervous system, and related studies suggest that GABAergic neurosteroids may be involved in some of the pharmacological effects of ethanol and that neurological This suggests that active steroids may be useful in treating ethanol withdrawal.

In view of the above, it is clear that there are numerous potentially beneficial uses for neurosteroids. As a result, there is a continuing need for the synthesis and understanding of new neuroactive steroids, particularly those having utility as anesthetics and/or in the treatment of disorders related to GABA function and activity.

In one aspect, the present disclosure relates to a compound having the structure of Formula (I): or a pharmaceutically acceptable salt thereof.

<Formula I>

In the above formula:

R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO(C ₁ -C ₄ alkyl)C (O), wherein R ₁ , when other than =O, is preferably in the beta position and/or in one or more preferred embodiments wherein _{C 1} -C _{4 alkyl is methyl, R 1} is thus methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)- and OHCH ₂ C(O)-;

R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;

R ₃ is H, optionally substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, optionally substituted C ₂ -C ₄ alkynyl, or optionally substituted aryl;

R ₄ is independently selected from H and unsubstituted C ₁ -C ₄ alkyl;

R ₅ is substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, or optionally substituted C ₂ -C ₄ alkynyl (in particular is alkoxy-substituted methyl, or more particularly R _b is _{-CH 2} -OR _b which is C ₁ -C ₄ alkyl, or even more particularly -CH ₂ -OCH ₃ );

R ₆ is H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted C ₁ -C ₄ alkoxy;

R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;

R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;

- - - represents an optional, further C-C bond which creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the R 5} -H substituent is absent and ;

- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that when present, R 1} is not =O.

The present disclosure further relates to a pharmaceutically acceptable salt of said compound, or alternatively a prodrug thereof. In one particular embodiment, the present disclosure relates to a compound having the structure of Formula II: or a pharmaceutically acceptable salt thereof.

<Formula II>

In the above formula:

R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO(C ₁ -C ₄ alkyl)C (O), wherein R ₁ , when other than =O, is preferably in the beta position and/or in one or more preferred embodiments wherein _{C 1} -C _{4 alkyl is methyl, R 1} is thus methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)- and OHCH ₂ C(O)-;

R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;

R _x is =O or OR _d , wherein R _d is H or C(O)R _e , wherein R _e is optionally substituted C ₁ -C ₂₂ alkyl or optionally substituted C ₂ -C ₂₂ alkenyl, provided that when R _x is OH, it is in the beta configuration;

R ₄ is independently selected from H and unsubstituted C ₁ -C ₄ alkyl;

R ₅ is substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, or optionally substituted C ₂ -C ₄ alkynyl (in particular is alkoxy-substituted methyl, or more particularly R _b is _{-CH 2} -OR _b which is C ₁ -C ₄ alkyl, or even more particularly -CH ₂ -OCH ₃ );

R ₆ is H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted C ₁ -C ₄ alkoxy;

R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;

R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;

- - - represents an optional, additional C-C bond that creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the C 5} -H substituent is absent and ;

- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that if present, R 1} is not =O;

provided that the compound does not have one of the following structures:

or alternatively, with the proviso that (i) when R _x is =O, a C═C _{bond is between C 4 -C 5} and R ₅ is CH ₂ OCH ₃ , then R ₁ is methoxy, spirooxy lan, cyano, nitro, and CH ₃ C(O)—; (ii) when R _x is beta-OH, a C=C bond is present between _{C 5} -C _{6 and R 5} is CH ₂ OCH ₃ , then R ₁ is methoxy, spirooxirane, cyano, nitro, and HOCH ₂ C(O)—.

The present disclosure further relates to pharmaceutical compositions comprising a therapeutically effective amount of one or more of the above-mentioned steroids, or prodrugs, or pharmaceutically acceptable salts thereof, and optionally a pharmaceutically acceptable carrier. The present disclosure also provides kits comprising a steroid, a salt thereof, a prodrug thereof, and/or a pharmaceutical composition thereof.

The present disclosure further provides a subject in need of induction of anesthesia comprising administering to the subject a therapeutically effective amount of one or more of the above-mentioned steroids, or prodrugs, or pharmaceutically acceptable salts, or pharmaceutical compositions thereof. provides a method for inducing anesthesia in

The present disclosure further provides for administering to a subject in need thereof a therapeutically effective amount of one or more of the above indicated steroids, or prodrugs, or pharmaceutically acceptable salts, or pharmaceutical compositions thereof. There is provided a method of treating the disorder in a subject, comprising: In certain embodiments, the disorder is selected from the group consisting of insomnia, mood disorders, convulsive disorders, anxiety, or ethanol withdrawal symptoms.

According to the present disclosure, a compound having a specific 17-substituted steroid structure, more specifically a specific 19-alkoxy-17-substituted steroid structure, and even more specifically a specific 19-methoxy-17-substituted steroid structure; It has also been found that pharmaceutically acceptable salts and prodrugs thereof are neuroactive and also suitable for use as anesthetics and in the treatment of disorders associated with GABA function. The compounds can be used, for example, as effective continuous infusion sedatives for non-surgical procedures (eg colonoscopy). The compounds also provide advantages over anesthetics known in the art, such as a lower likelihood of bacterial contamination, as well as an improved relationship with solubilizers.

1. Steroid Structure

In general, the steroids of the present disclosure have a tetracyclic, fused ring structure, such as a cyclopenta[a]phenanthrene ring system, embodiments of which are illustrated and discussed in greater detail below, wherein the A ring the C ₃ -position has a hydroxyl substituent in the α-position and the C ₁₇ -position of the D ring is methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)-, and HOCH ₂ C (O)- has a substituent attached to it selected from the group consisting of (R ₁ , when other than =O, is preferably in the beta position).

However, more particularly, the present disclosure relates, in certain embodiments, to a steroid having the structure of Formula (I): or a pharmaceutically acceptable salt thereof.

<Formula I>

In the above formula:

R ₁ is (C ₁ -C ₄ alkyl)-O (eg methoxy, ethoxy, propoxy, butoxy), spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl )C(O) (eg, CH ₃ C(O), CH ₃ CH ₂ C(O), CH ₃ CH ₂ CH ₂ C(O), CH ₃ CH ₂ CH ₂ CH ₂ C(O)) , and HO(C ₁ -C ₄ alkyl)C(O) (eg, HOCH ₂ C(O), HOCH ₂ CH ₂ C(O), HOCH ₂ CH ₂ CH ₂ C(O), HOCH ₂ CH ₂ CH ₂ CH ₂ C(O)), wherein R ₁ , when other than =O, is preferably in the beta position and/or C ₁ -C ₄ alkyl is methyl. In an embodiment R ₁ is thus selected from methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)— and OHCH ₂ C(O)—;

R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;

R ₃ is H, optionally substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, optionally substituted C ₂ -C ₄ alkynyl, or optionally substituted aryl;

R ₄ is independently selected from H and unsubstituted C ₁ -C ₄ alkyl;

R ₅ is substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, or optionally substituted C ₂ -C ₄ alkynyl (in particular is alkoxy-substituted methyl, or more particularly R _b is _{-CH 2} -OR _b which is C ₁ -C ₄ alkyl, or even more particularly -CH ₂ -OCH ₃ );

R ₆ is H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted C ₁ -C ₄ alkoxy;

R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;

R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;

- - - represents an optional, further C-C bond which creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the R 5} -H substituent is absent and ;

- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that when present, R 1} is not =O.

As generally defined above, R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO( C ₁ -C ₄ alkyl)C(O). In certain embodiments, R ₁ is preferably in the beta position (if other than =O, or if C=C is not present between _{C 16} -C _{17 ).} In certain embodiments, R ₁ is (C ₁ -C ₄ alkyl)-O (eg, methoxy, ethoxy, propoxy, butoxy), spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O) (eg, CH ₃ C(O), CH ₃ CH ₂ C(O), CH ₃ CH ₂ CH ₂ C(O), CH ₃ CH ₂ CH ₂ CH ₂ C(O)), and HO(C ₁ -C ₄ alkyl)C(O) (eg, HOCH ₂ C(O), HOCH ₂ CH ₂ C(O), HOCH ₂ CH ₂ CH ₂ C(O)) ), HOCH ₂ CH ₂ CH ₂ CH ₂ C(O)). In certain embodiments, C ₁ -C ₄ alkyl is methyl and R ₁ is thus from methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)— and OHCH ₂ C(O)—. is chosen

As generally defined above, R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, provided that R ₂ is When =O, R ₈ is absent. In certain embodiments, R ₂ is =O and R ₈ is absent. In certain embodiments, R ₂ is H. In certain embodiments, R ₂ is OR _a . In certain embodiments, R ₂ is OR _a , R _a is optionally substituted C ₁ , C ₂ , C ₃ , or C ₄ alkyl (eg, methyl, ethyl), optionally substituted benzyl, or O-aryl C ₁ , C ₂ , C ₃ , or C ₄ alkyl substituted with , such as O-benzyl. In certain embodiments, R ₂ is OR _a and R _a is optionally substituted aryl. In certain embodiments, R ₂ is OR _a and R _a is H.

As generally defined above, R ₃ is H, optionally substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, optionally substituted C ₂ -C ₄ alkynyl, or optionally substituted aryl. to be. In certain embodiments, R ₃ is H. In certain embodiments, R ₃ is optionally substituted C ₁ , C ₂ , C ₃ or C ₄ alkyl (eg, methyl, ethyl, trifluoromethyl, difluoromethyl). In certain embodiments, R ₃ is methyl. In certain embodiments, R ₃ is trifluoromethyl. In certain embodiments, R ₃ is optionally substituted C ₂ , C ₃ or C ₄ alkenyl (eg, optionally substituted allyl). In certain embodiments, R ₃ is optionally substituted C ₂ , C ₃ , or C ₄ alkynyl (eg, optionally substituted acetylene or optionally substituted propargyl). In certain embodiments, R ₃ is optionally substituted aryl (eg, optionally substituted phenyl, such as OH, methyl, or COR _c , wherein R _c is, for example, optionally substituted C ₁ , C ₂ , C ₃ , C ₄ , C ₅ , C ₆ , C ₇ , C ₈ , C ₉ , C ₁₀ , C ₁₁ , C ₁₂ , C ₁₃ , C ₁₄ , C ₁₅ , C ₁₆ , C ₁₇ , C ₁₈ , C ₁₉ , C ₂₀ , C ₂₁ , or C ₂₂ alkyl or C ₂ , C ₃ , C ₄ , C ₅ , C ₆ , C ₇ , C ₈ , C ₉ , C ₁₀ , C ₁₁ , C ₁₂ , C ₁₃ , C ₁₄ , C ₁₅ , optionally substituted with _{C 16, C 17, C 18} , C 19, C 20, C 21, or C _22, including the Al, alkenyl optionally substituted with C ₁ -C ₂₂ alkyl or an optionally substituted C ₂ -C ₂₂ alkenyl nilim) phenyl).

As generally defined above, R ₄ is H or unsubstituted C ₁ -C ₄ alkyl. In certain embodiments, R ₄ is H. In certain embodiments, R ₄ is unsubstituted C ₁ , C ₂ , C ₃ or C ₄ alkyl (eg, methyl, ethyl, n-propyl, isopropyl, or n-butyl).

As generally defined above, R ₅ is substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, or optionally substituted C ₂ -C ₄ alkynyl. In certain embodiments, R ₅ is substituted C ₁ -C ₄ alkyl, particularly alkoxy-substituted C ₁ -C ₄ alkyl. In another particular embodiment, R ₅ is substituted methyl, more particularly alkoxy-substituted methyl (or even more particularly —CH ₂ -OR _{b wherein R b} is C ₁ -C ₄ alkyl, or more particularly —CH ₂ -OCH ₃ ). In other embodiments, R ₅ is optionally substituted C ₂ -C ₄ alkenyl. In other embodiments, R ₅ is optionally substituted C ₂ -C ₄ alkynyl.

As generally defined above, R ₆ is H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted C ₁ -C ₄ alkoxy. In certain embodiments, R ₆ is H. In certain embodiments, R ₆ is optionally substituted C ₁ , C ₂ , C ₃ , or C ₄ alkyl (eg, methyl). In certain embodiments, R ₆ is optionally substituted C ₁ , C ₂ , C ₃ or C ₄ alkoxy (eg, methoxy, ethoxy, n-propyloxy, isopropyloxy, or n-butoxy). . In certain embodiments, when R ₆ is a non-hydrogen group, then R ₆ is in the alpha (downward) position. However, in certain preferred embodiments, when R ₆ is a non-hydrogen group, R ₆ is in the beta (upper) position.

As generally defined above, R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring. In certain embodiments, R ₇ is H. In certain embodiments, R ₇ is optionally substituted C ₁ , C ₂ , C ₃ or C ₄ alkoxy (eg, methoxy, ethoxy, n-propyloxy, isopropyloxy, or n-butoxy). . In certain embodiments, R ₇ is an optionally substituted morpholinyl ring. In certain embodiments, when R ₇ is a non-hydrogen group, then R ₇ is in the alpha (downward) position. However, in certain preferred embodiments _{, R 7} is in the beta (upper) position _{when R 7} is a non-hydrogen group.

As generally defined above, R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R ₈ is H. In certain embodiments, R ₈ is C ₁ , C ₂ , C ₃ or C ₄ optionally substituted alkyl (eg, methyl). In certain embodiments, when R ₈ is optionally substituted C ₁ -C ₄ alkyl, then R ₈ is in the alpha (downward) position. In certain embodiments, when R ₈ is optionally substituted C ₁ -C ₄ alkyl, then R ₈ is in the beta (upper) position.

In certain embodiments, R ₂ and R ₈ are both H. In certain embodiments, R ₂ is OR _a and R ₈ is H.

As generally defined above, - - - represents an optional, additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 , provided that, if present, C} There is no _{5-H substituent.} In certain embodiments, an additional CC bond is absent and _{the hydrogen at C 5 is} in the alpha or beta position. In certain embodiments, an additional CC bond is absent and _{the hydrogen at C 5 is} in the alpha (downward) position. In certain embodiments, the additional CC bond is absent and _{the hydrogen at C 5 is} in the beta (up) position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 4} -C _{5 .} In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 5} -C _{6 .}

As generally defined above, - - - represents an optional, additional C-C bond that creates a C=C bond between _{C 16} -C _{17 , provided that, when present, R 1} is other than =O. . In certain embodiments, additional C-C bonds are absent (ie, no C=C bonds are present), and thus R ₁ may be in the alpha or beta position. In certain embodiments, an additional CC bond is absent and R ₁ is in the alpha (downward) position. In certain embodiments, an additional CC bond is absent and R ₁ is in the beta (upper) position.

It is noted that this disclosure contemplates and is intended to encompass all the various combinations and permutations possible herein (ie, combinations of substituent options, positions, and stereochemical configurations).

For example, in various embodiments, compounds of the present disclosure include: R ₂ is =O; Alternatively, R ₂ can be H and R ₈ is H (eg C ₁₁ thus has two hydrogen atoms attached thereto as substituents) to be selected from those encompassed by the structure of Formula (I). can In certain embodiments, R ₂ can be OR _a , where R _{a is C 1} -C ₄ alkyl substituted with methyl, optionally substituted benzyl, or O-aryl, such as O-benzyl. In certain embodiments, R ₃ is H, methyl, trifluoromethyl, or substituted aryl (eg, substituted phenyl, which in turn may be optionally substituted, such as by _{, for example, OH, methyl, or COR c )} , wherein R _c = C ₁ -C ₄ alkyl; Further, when R ₃ is anything other than H, R ₃ is preferably in the β-position. In certain embodiments, each of R ₄ and R ₆ is independently selected from H and methyl, R ₅ is in the β-configuration, and R ₆ is optionally in the α- or β-configuration (eg R _{6 )} methyl), the β-configuration is preferred. In certain embodiments, R ₇ is selected from H, methoxy, ethoxy, and an optionally substituted morpholinyl ring; Further, when R ₇ is anything other than H, R ₇ is preferably in the β-position. In certain embodiments, R ₈ , when present, is selected from H or optionally substituted C ₁ -C _{4 alkyl.} In certain embodiments, R ₈ is methyl (eg, methyl in the alpha-configuration).

In certain embodiments, C ₅ -H is in the alpha configuration and R ₅ is a substituted methyl group, eg, in the beta configuration (eg, alkoxy-substituted methyl, or particularly methoxy-substituted methyl) . In certain embodiments, C ₅ -H is in the beta configuration and R ₅ is a substituted methyl (eg, methoxy-substituted methyl) group, eg, in the beta configuration. In certain embodiments, R ₆ is H. In certain embodiments, R ₄ is methyl. In certain embodiments, R ₂ is =O or methoxy.

Thus, as shown, steroids of formula (I) may encompass a number of different structures in accordance with the present disclosure.

In certain embodiments, a compound of Formula Ia, or a compound thereof _{, wherein R 1} is as defined above, R ₃ is in the beta position, R ₄ is methyl, R ₅ is substituted methyl in the beta position, and R _{6 is H;} Pharmaceutically acceptable salts are provided.

<Formula I-a>

wherein - - -, R ₂ , R ₃ , R ₇ and R ₈ are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, there is provided a compound of Formula Ib, or a pharmaceutically acceptable salt thereof _{, wherein R 2} is =O and R _{8 is absent.}

<Formula I-b>

wherein - - -, R ₃ and R ₇ are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, _{there is provided a compound of Formula Ic wherein R 2} and R ₈ are H, or a pharmaceutically acceptable salt thereof.

<Formula I-c>

wherein - - -, R ₂ , R ₃ , and R ₇ are as defined herein _{, and further R b} is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, there is provided a compound of Formula Id, or a pharmaceutically acceptable salt thereof _{, wherein R 2} is OR _a and R _{8 is H.}

<Formula I-d>

wherein - - -, R ₃ , R ₇ , and R _a are as defined herein _{, and further R b} is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, _{there is provided a compound of Formula Ie, wherein R 7} is H, or a pharmaceutically acceptable salt thereof.

<Formula I-e>

wherein - - -, R ₂ , R ₃ , and R ₈ are as defined herein _{, and further R b} is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of formula I, there is provided a compound of formula If, or a pharmaceutically acceptable salt thereof, wherein each occurrence of - - - is absent and C _{5 -H is in the alpha position.}

<Formula I-f>

wherein R ₂ , R ₃ , R ₇ and R ₈ are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, _{there is provided a compound of Formula Ig, wherein R 7} is H, or a pharmaceutically acceptable salt thereof.

<Formula I-g>

wherein R ₂ , R ₃ , and R ₈ are as defined herein _{, and further R b} is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, _{there is provided a compound of Formula Ih, wherein R 2} is =O, or a pharmaceutically acceptable salt thereof.

<Formula I-h>

wherein R ₃ and R ₇ are as defined herein and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of Formula I, there is provided a compound of Formula Ii, or a pharmaceutically acceptable salt thereof _{, wherein R 2} is OR _a.

<Formula I-i>

wherein R _a , R ₃ , and R ₇ are as defined herein _{, and further R b} is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of formula I, there is provided a compound of formula Ij, or a pharmaceutically acceptable salt thereof _{, wherein - - - represents a further C-C bond forming a C=C bond between C 4} -C _{5 .}

<Formula I-j>

wherein R ₃ , R ₂ , R ₇ and R ₈ are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In certain embodiments of formula I, there is provided a compound of formula Ik, or a pharmaceutically acceptable salt thereof _{, wherein - - - represents a further C-C bond forming a C=C bond between C 5} -C _{6 .}

<Formula I-k>

wherein R ₃ , R ₂ , R ₇ and R ₈ are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position.

In one or more of the preferred embodiments detailed above, R ₁ may in particular be selected from methoxy (or more generally lower alkoxy, for example —O—(C ₁ -C ₄ )), or alternatively CH ₃ C(O)- or HOCH ₂ C(O)- (or more generally substituted or unsubstituted lower alkyl-carbonyl, for example one or more of the carbon atoms optionally substituted, for example by a hydroxyl group (C ₁ -C ₄ )C(O)-). Alternatively, R ₁ may be selected from nitro or cyano, with optional C=C present between _{C 16} -C _{17 .} In another alternative embodiment, C ₁₇ can be a carbonyl carbon (ie, R ₁ is =O), or can be part of an oxirane ring fused with a D-ring (ie, R ₁ is spiro). an oxirane substituent, wherein C ₁₇ is a carbon atom common to both rings).

Exemplary compounds of Formula I are:

and pharmaceutically acceptable salts thereof, in one preferred embodiment R _b is CH ₃ .

In certain embodiments, the steroid of Formula (I) is:

and pharmaceutically acceptable salts thereof, wherein R ₃ is as defined above, in one particular embodiment is H, and further in this or another preferred embodiment R _b is CH ₃ to be.

In certain embodiments, the steroid of Formula (I) is:

and pharmaceutically acceptable salts thereof, wherein R ₃ is as defined above, in one particular embodiment is H, and further in this or another preferred embodiment R _b is CH ₃ to be.

In certain embodiments, the steroid of Formula (I) is:

and pharmaceutically acceptable salts thereof, wherein R ₃ and/or R ₁ are as defined above, and in one particular embodiment R ₃ is H, R ₁ is methoxy, and further In these or other preferred embodiments R _b is CH ₃ .

In certain embodiments, the steroid of Formula (I) is:

and pharmaceutically acceptable salts thereof, wherein R ₃ is as defined above, in one particular embodiment is H, and further in this or another preferred embodiment R _b is CH ₃ to be.

In certain embodiments, the steroid of Formula (I) is:

and pharmaceutically acceptable salts thereof, wherein R ₃ is as defined above, in one particular embodiment is H, and further in this or another preferred embodiment R _b is CH ₃ to be.

In this regard, it is noted that the structures provided above are those of various exemplary embodiments. As such, they should not be taken in a limiting sense.

2. Prodrug Structure

In another specific embodiment, the present disclosure relates generally to prodrugs of the various steroids detailed above. In general, "prodrug" as used herein refers to a form of the above-mentioned steroid (and in particular a steroid of formula I) that is inactive, or significantly less active, which, following administration, is a form of the steroid of formula (I) in vivo. metabolized to one or more active metabolites. Prodrugs may be formed using means generally known in the art, and thus may take essentially any form that will be recognized by one of ordinary skill in the art. The prodrugs of the present disclosure may advantageously provide improved absorption, distribution, metabolism and/or excretion optimization of the steroids described above (and particularly those of formula I), as well as improved oral bioavailability.

In another specific embodiment of the present disclosure, a prodrug of a steroid disclosed herein has the structure of Formula II: or a pharmaceutically acceptable salt thereof.

<Formula II>

In the above formula:

R ₁ is (C ₁ -C ₄ alkyl)-O (eg methoxy, ethoxy, propoxy, butoxy), spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl )C(O) (eg, CH ₃ C(O), CH ₃ CH ₂ C(O), CH ₃ CH ₂ CH ₂ C(O), CH ₃ CH ₂ CH ₂ CH ₂ C(O)) , and HO(C ₁ -C ₄ alkyl)C(O) (eg, HOCH ₂ C(O), HOCH ₂ CH ₂ C(O), HOCH ₂ CH ₂ CH ₂ C(O), HOCH ₂ CH ₂ CH ₂ CH ₂ C(O)), wherein R ₁ , when other than =O, is preferably in the beta position and/or C ₁ -C ₄ alkyl is methyl. In an embodiment R ₁ is thus selected from methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)— and OHCH ₂ C(O)—;

R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;

R _x is =O or OR _d , wherein R _d is H or C(O)R _e , wherein R _e is optionally substituted C ₁ -C ₂₂ alkyl or optionally substituted C ₂ -C ₂₂ alkenyl, provided that when R _x is OH, it is in the beta configuration;

R ₄ is independently selected from H and unsubstituted C ₁ -C ₄ alkyl;

R ₅ is substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, or optionally substituted C ₂ -C ₄ alkynyl (in particular is alkoxy-substituted methyl, or more particularly R _b is _{-CH 2} -OR _b which is C ₁ -C ₄ alkyl, or even more particularly -CH ₂ -OCH ₃ );

R ₆ is H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted C ₁ -C ₄ alkoxy;

R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;

R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;

- - - represents an optional, additional C-C bond that creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the C 5} -H substituent is absent and ;

- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that if present, R 1} is not =O;

provided that the compound does not have one of the following structures:

or alternatively, with the proviso that (i) when R _x is =O, a C═C _{bond is between C 4 -C 5} and R ₅ is CH ₂ OCH ₃ , then R ₁ is methoxy, spirooxy lan, cyano, nitro, and CH ₃ C(O)—; (ii) when R _x is beta-OH, a C=C bond is present between _{C 5} -C _{6 and R 5} is CH ₂ OCH ₃ , then R ₁ is methoxy, spirooxirane, cyano, nitro, and HOCH ₂ C(O)—.

In this regard, it is noted that the present disclosure contemplates and is intended to encompass all the various combinations and permutations (ie, combinations of substituent options, positions, and stereochemical configurations) possible herein.

As generally defined above, R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO( C ₁ -C ₄ alkyl)C(O). In certain embodiments, R ₁ is preferably in the beta position (if other than =O, or if C=C is not present between _{C 16} -C _{17 ).} In certain embodiments, R ₁ is (C ₁ -C ₄ alkyl)-O (eg, methoxy, ethoxy, propoxy, butoxy), spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O) (eg, CH ₃ C(O), CH ₃ CH ₂ C(O), CH ₃ CH ₂ CH ₂ C(O), CH ₃ CH ₂ CH ₂ CH ₂ C(O)), and HO(C ₁ -C ₄ alkyl)C(O) (eg, HOCH ₂ C(O), HOCH ₂ CH ₂ C(O), HOCH ₂ CH ₂ CH ₂ C(O)) ), HOCH ₂ CH ₂ CH ₂ CH ₂ C(O)). In certain embodiments, C ₁ -C ₄ alkyl is methyl and R ₁ is thus from methoxy, spirooxirane, cyano, =O, nitro, CH ₃ C(O)— and OHCH ₂ C(O)—. is chosen

As generally defined above, R _x is =O or OR _d , wherein R _d is H or C(O)R _e , wherein R _e is optionally substituted C ₁ -C ₂₂ alkyl or optionally substituted C _2- C ₂₂ alkenyl (eg optionally substituted C ₁ , C ₂ , C ₃ , C ₄ , C ₅ , C ₆ , C ₇ , C ₈ , C ₉ , C ₁₀ , C ₁₁ , C ₁₂ , C ₁₃ , C ₁₄ , C ₁₅ , C ₁₆ , C ₁₇ , C ₁₈ , C ₁₉ , C ₂₀ , C ₂₁ , or C ₂₂ alkyl or C ₂ , C ₃ , C ₄ , C ₅ , C ₆ , C ₇ , C ₈ , C ₉ , C ₁₀ , C ₁₁ , C ₁₂ , C ₁₃ , C ₁₄ , C ₁₅ , C ₁₆ , C ₁₇ , C ₁₈ , C ₁₉ , C ₂₀ , C ₂₁ , or C ₂₂ alkenyl); provided that R _x is OH, it is in the beta (upper) configuration. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, R _x is OR _d , R _d is C(O)R _e , and R _e is optionally substituted C ₁ -C ₂₂ alkyl or optionally substituted C ₂ -C ₂₂ alkenyl, for example C(O)CH ₃ , in which case the group R _x is provided in the alpha or beta configuration (beta configuration is preferred). In certain embodiments, when R _x is OR _d and R _d is H, then R _x is OH in the beta (up) configuration.

As generally defined above, R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, provided that R ₂ is When =O, R ₈ is absent. In certain embodiments, R ₂ is =O and R ₈ is absent. In certain embodiments, R ₂ is H. In certain embodiments, R ₂ is OR _a . In certain embodiments, R ₂ is OR _a , R _a is optionally substituted C ₁ , C ₂ , C ₃ , or C ₄ alkyl (eg, methyl, ethyl), optionally substituted benzyl, or O-aryl C ₁ , C ₂ , C ₃ , or C ₄ alkyl substituted with , such as O-benzyl. In certain embodiments, R ₂ is OR _a and R _a is optionally substituted aryl. In certain embodiments, R ₂ is OR _a and R _a is H.

As generally defined above, R ₄ is H or unsubstituted C ₁ -C ₄ alkyl. In certain embodiments, R ₄ is H. In certain embodiments, R ₄ is unsubstituted C ₁ , C ₂ , C ₃ or C ₄ alkyl (eg, methyl, ethyl, n-propyl, isopropyl, or n-butyl).

As generally defined above, R ₅ is substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, or optionally substituted C ₂ -C ₄ alkynyl. In certain embodiments, R ₅ is substituted C ₁ -C ₄ alkyl, particularly alkoxy-substituted C ₁ -C ₄ alkyl. In another particular embodiment, R ₅ is substituted methyl, more particularly alkoxy-substituted methyl (or even more particularly —CH ₂ -OR _{b wherein R b} is C ₁ -C ₄ alkyl, or more particularly —CH ₂ -OCH ₃ ). In other embodiments, R ₅ is optionally substituted C ₂ -C ₄ alkenyl. In other embodiments, R ₅ is optionally substituted C ₂ -C ₄ alkynyl.

As generally defined above, R ₆ is H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted C ₁ -C ₄ alkoxy. In certain embodiments, R ₆ is H. In certain embodiments, R ₆ is optionally substituted C ₁ , C ₂ , C ₃ , or C ₄ alkyl (eg, methyl). In certain embodiments, R ₆ is optionally substituted C ₁ , C ₂ , C ₃ or C ₄ alkoxy (eg, methoxy, ethoxy, n-propyloxy, isopropyloxy, or n-butoxy). . In certain embodiments, when R ₆ is a non-hydrogen group, then R ₆ is in the alpha (downward) position. However, in certain preferred embodiments, when R ₆ is a non-hydrogen group, R ₆ is in the beta (upper) position.

As generally defined above, R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring. In certain embodiments, R ₇ is H. In certain embodiments, R ₇ is optionally substituted C ₁ , C ₂ , C ₃ or C ₄ alkoxy (eg, methoxy, ethoxy, n-propyloxy, isopropyloxy, or n-butoxy). . In certain embodiments, R ₇ is an optionally substituted morpholinyl ring. In certain embodiments, when R ₇ is a non-hydrogen group, then R ₇ is in the alpha (downward) position. However, in certain preferred embodiments _{, R 7} is in the beta (upper) position _{when R 7} is a non-hydrogen group.

As generally defined above, R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R ₈ is H. In certain embodiments, R ₈ is C ₁ , C ₂ , C ₃ or C ₄ optionally substituted alkyl (eg, methyl). In certain embodiments, when R ₈ is optionally substituted C ₁ -C ₄ alkyl, then R ₈ is in the alpha (downward) position. In certain embodiments, when R ₈ is optionally substituted C ₁ -C ₄ alkyl, then R ₈ is in the beta (upper) position.

In certain embodiments, R ₂ and R ₈ are both H. In certain embodiments, R ₂ is OR _a and R ₈ is H.

As generally defined above, - - - represents an optional, additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 , provided that, if present, C} There is no _{5-H substituent.} In certain embodiments, an additional CC bond is absent and _{the hydrogen at C 5 is} in the alpha or beta position. In certain embodiments, an additional CC bond is absent and _{the hydrogen at C 5 is} in the alpha (downward) position. In certain embodiments, the additional CC bond is absent and _{the hydrogen at C 5 is} in the beta (up) position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 4} -C _{5 .} In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 5} -C _{6 .}

As generally defined above, - - - represents an optional, additional C-C bond that creates a C=C bond between _{C 16} -C _{17 , provided that, when present, R 1} is other than =O. . In certain embodiments, additional C-C bonds are absent (ie, no C=C bonds are present), and thus R ₁ may be in the alpha or beta position. In certain embodiments, an additional CC bond is absent and R ₁ is in the alpha (downward) position. In certain embodiments, an additional CC bond is absent and R ₁ is in the beta (upper) position.

In certain embodiments, prodrugs of the present disclosure may be selected from those encompassed by structures of Formula II, wherein _{R 2 is =O.} In certain embodiments, R ₂ is H, R ₈ is H, eg C ₁₁ thus has two hydrogen atoms bonded thereto as substituents. In certain embodiments, R ₂ can be OR _a , wherein R _a is methyl, optionally substituted benzyl, O-aryl substituted or C ₁ -C ₄ alkyl, such as O-benzyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is β-hydroxy. In certain embodiments, R _x is OR _d , wherein R _d is H or C(O)R _e , wherein R _e is optionally substituted C ₁ -C ₄ alkyl (eg, methyl). In certain embodiments, each of R ₄ and R ₆ is independently selected from H and methyl. In certain embodiments, R ₆ is optionally substituted alkyl, eg, methyl, optionally in the alpha-configuration in the absence of a carbon-carbon double bond between _{C 5} -C _{6 .} In certain embodiments, R ₆ is optionally substituted alkyl, eg, methyl, optionally in beta-configuration in the absence of a carbon-carbon double bond between _{C 5} -C _{6 .} In certain embodiments, R ₇ is selected from H, methoxy, ethoxy, and an optionally substituted morpholinyl ring. In certain embodiments, R ₇ is a non-hydrogen group and R ₇ is in the β-position. In certain embodiments, carbon-carbon double bonds (or unsaturated bonds) may be present between _{C 4} -C ₅ or C ₅ -C _{6 carbon atoms.} In certain embodiments, R ₈ , when present, is selected from H or optionally substituted C ₁ -C ₄ alkyl, preferably methyl, more preferably alpha-methyl.

In certain embodiments, R _x is OH and is in the beta position. In certain embodiments, the carbon-carbon double bond is _{between C 4} -C ₅ carbon atoms. In certain embodiments, the carbon-carbon double bond is _{between C 5} -C ₆ carbon atoms. In certain embodiments, R ₂ is =O. In certain embodiments, R ₂ is methoxy. In certain embodiments, R ₇ is H. In certain embodiments, R ₇ is β-methoxy. In certain embodiments, R ₇ is β-ethoxy.

In certain embodiments is provided a compound of Formula II-a, or a pharmaceutically acceptable salt thereof _{, wherein R 4} is methyl, R ₅ is substituted methyl in the beta position, and R _{6 is H.}

<Formula II-a>

wherein R ₁ , — — —, R _x , R ₂ , R ₇ (preferably in beta configuration) and R ₈ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted is C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, - - - represents an additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 .} In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, there is provided a compound of Formula II-b, or a pharmaceutically acceptable salt thereof _{, wherein R 2} is =O and R _{8 is absent.}

<Formula II-b>

wherein R ₁ , — — —, R _x , and R ₇ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, - - - represents an additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 .} In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, there is provided a compound of Formula II-c, _{wherein R 2} is H and R _{8 is H, or a pharmaceutically acceptable salt thereof.}

<Formula II-c>

wherein R ₁ , — — —, R _x , and R ₇ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of C ₅ -C ₆ and C ₆ -C ₇ - - - is absent and C ₅ -H is in the beta position. In certain embodiments, - - - represents an additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 .} In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, there is provided a compound of Formula II-d, or a pharmaceutically acceptable salt thereof _{, wherein R 2} is OR _a and R _{8 is H.}

<Formula II-d>

wherein R ₁ , — — —, R ₃ , R ₇ (preferably in beta configuration), and R _a are as defined herein _{, and further R b} is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, each instance of - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of - - - is absent and C ₅ -H is in the beta position. In certain embodiments, - - - represents an additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 .} In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, there is provided a compound of Formula II-e _{, wherein R 7 is H, or a pharmaceutically acceptable salt thereof.}

<Formula II-e>

wherein R ₁ , — — —, R _x , R ₂ and R ₈ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - is absent and C ₅ -H is in the alpha position. In certain embodiments, each instance of - - - is absent and C ₅ -H is in the beta position. In certain embodiments, - - - represents an additional C-C bond that results in a C=C bond _{between C 4} -C ₅ or between C ₅ -C _{6 .} In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula (II), provided is a compound of Formula (II-f), or a pharmaceutically acceptable salt thereof, wherein each occurrence of - - - is absent and C _{5 -H is in the alpha position.}

<Formula II-f>

wherein R ₁ , R _x , R ₂ , R ₇ (preferably in beta configuration) and R ₈ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ - C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, provided is a compound of Formula II-g _{, wherein R 7 is H, or a pharmaceutically acceptable salt thereof.}

<Formula II-g>

wherein R ₁ , R _x , R ₂ and R ₈ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, there is provided a compound of Formula II-h _{, wherein R 2 is =O, or a pharmaceutically acceptable salt thereof.}

<Formula II-h>

wherein R ₁ , R _x and R ₇ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of Formula II, there is provided a compound of Formula II-i wherein _{R 2} is OR _{a , or a pharmaceutically acceptable salt thereof.}

<Formula II-i>

wherein R ₁ , R _x , R _a , and R ₇ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ -C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of formula II, there is provided a compound of formula II-j, or a pharmaceutically acceptable salt thereof, wherein - - - _{represents an additional C-C bond forming a C=C bond between C 4} -C ₅ .

<Formula II-j>

wherein R ₁ , R _x , R ₂ , R ₇ (preferably in beta configuration) and R ₈ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ - C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In certain embodiments of formula II there is provided a compound of formula II-k, or a pharmaceutically acceptable salt thereof, wherein - - - _{represents a further C-C bond forming a C=C bond between C 5} -C ₆ .

<Formula II-k>

wherein R ₁ , R _x , R ₂ , R ₇ (preferably in beta configuration) and R ₈ (preferably in beta configuration) are as defined herein, and further R _b is optionally substituted C ₁ - C ₄ alkyl. In certain embodiments, R _x is =O. In certain embodiments, R _x is OH in the beta (up) configuration. In certain embodiments, each instance of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. In certain embodiments, - - - represents an additional C-C bond that creates a C=C bond between _{C 16} -C _{17 .}

In one or more of the preferred embodiments detailed above, R ₁ may in particular be selected from methoxy (or more generally lower alkoxy, eg —O—(C ₁ -C ₄ )), or alternatively CH ₃ C(O)- or HOCH ₂ C(O)- (or more generally substituted or unsubstituted lower alkyl-carbonyl, eg one or more of the carbon atoms optionally, eg, by a hydroxyl group substituted (C ₁ -C ₄ )C(O)—). Alternatively, R ₁ may be selected from nitro or cyano, with optional C=C present between _{C 16} -C _{17 .} In another alternative embodiment, C ₁₇ can be a carbonyl carbon (ie, R ₁ is =O), or it can be part of an oxirane ring fused with a D-ring (ie, R ₁ is spirooxy). is a substituent, wherein C ₁₇ is a carbon atom common to both rings).

Exemplary compounds of Formula II are:

and pharmaceutically acceptable salts thereof, in one preferred embodiment R _b is CH ₃ .

In this regard, it is noted that the structures provided above are those of various exemplary embodiments. As such, they should not be taken in a limiting sense.

3. Methods of Preparation and Pharmaceutical Compositions

It is noted that a compound or steroid or prodrug thereof of the present disclosure may be prepared in various embodiments or used according to means generally known in the art. For example, in certain embodiments, a steroid or prodrug of the present disclosure may be prepared or used in the form of a pharmaceutically acceptable salt _{, eg, wherein R 7 is an optionally substituted morpholinyl ring.} Suitable salt forms include, for example, citrate or chloride salt forms.

In various embodiments of the present disclosure, a pharmaceutical composition is disclosed that may include a steroid, a prodrug, or a combination of two or more thereof according to the formulas of the present disclosure. Compounds or steroids (or prodrugs thereof) of the present disclosure, as well as various salt forms and other pharmaceutically acceptable forms, such as solvates and/or hydrates of the compounds described herein, and pharmaceutical compositions containing them, are generally may be prepared using methods and techniques known in the art and/or as described in the Examples provided herein.

Without wishing to be bound by any particular theory, a compound or steroid of the present disclosure _{may induce anesthesia by potentiating GABA at the GABA A} receptor in a subject, e.g., a human subject, or a disorder associated with GABA function (e.g., insomnia , mood disorders, convulsive disorders, anxiety disorders, or ethanol withdrawal symptoms), preferably administered in the form of a pharmaceutical composition comprising an effective amount of a compound of the present disclosure and optionally a pharmaceutically or pharmacologically acceptable carrier. do.

In one aspect, inducing anesthesia in a subject comprising administering to the subject in need thereof a therapeutically effective amount of one or more of said steroid, or a prodrug thereof, or a pharmaceutically acceptable salt, or a pharmaceutical composition thereof. method is provided.

In another aspect, comprising administering to a subject in need thereof a therapeutically effective amount of said steroid, or a prodrug thereof, or one or more of a pharmaceutically acceptable salt, or a pharmaceutical composition thereof, Methods of treating the disorder in a subject are provided. In certain embodiments, the disorder is selected from the group consisting of insomnia, mood disorders, convulsive disorders, anxiety, or ethanol withdrawal symptoms.

In one embodiment of the present disclosure, the therapeutically effective amount of the compound is from about 5 mg/kg to about 20 mg/kg, from about 5 mg/kg to about 18 mg/kg, from about 5 mg/kg to about 16 mg/kg, about 5 mg/kg to about 14 mg/kg, about 5 mg/kg to about 12 mg/kg, about 5 mg/kg to about 10 mg/kg, about 6 mg/kg to about 10 mg/kg, about 6 mg/kg to about 9 mg/kg, about 7 mg/kg to about 9 mg/kg, or about 8 mg/kg to about 16 mg/kg. In certain embodiments, the therapeutically effective amount of the compound is about 8 mg/kg. It will be appreciated that the dosage ranges as described herein provide guidance for the administration of the provided pharmaceutical compositions to adults. For example, the amount administered to an infant or adolescent may be determined by a medical practitioner or one of ordinary skill in the art, and may be less than or equal to the amount administered to an adult.

The exact amount of compound required to achieve an effective amount will vary from subject to subject, for example, depending on the species, age and general condition of the subject, the identity of the particular compound(s), mode of administration, and the like. The desired dosage may be delivered three times a day, twice a day, once a day, every other day, every three days, every week, every two weeks, every three weeks, or every four weeks. In certain embodiments, the desired dosage comprises multiple administrations (eg, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or more administrations). can be transmitted using

It will also be appreciated that a compound or composition as described herein may be administered in combination with one or more additional therapeutically active agents. The compound or composition may be administered in combination with an additional therapeutically active agent that improves its bioavailability, reduces and/or modifies its metabolism, inhibits its excretion, and/or modifies its distribution in the body. have.

The compound or composition may be administered concurrently, before or after one or more additional therapeutically active agents. Generally, each agent will be administered at a dose and/or time schedule determined for that agent. Additionally, it will be appreciated that the additional therapeutically active agents employed in such combinations may be administered together in a single composition or administered separately in different compositions. The particular combination for use in therapy will take into account the compatibility of the compound of the invention with the additional therapeutically active agent and/or the desired therapeutic effect to be achieved. In general, it is expected that the additional therapeutically active agents used in combination will be used at levels that do not exceed those at which they would be used individually. In some embodiments, the levels used in combination will be lower than the levels used individually. Exemplary therapeutically active agents include small organic molecules such as drug compounds (eg, compounds approved by the Food and Drug Administration as provided in the Code of Federal Regulations (CFR)), peptides, proteins, carbohydrates, monosaccharides, oligosaccharides , polysaccharides, nucleoproteins, mucoproteins, lipoproteins, synthetic polypeptides or proteins, small molecules linked to proteins, glycoproteins, steroids, nucleic acids, DNA, RNA, nucleotides, nucleosides, oligonucleotides, antisense oligonucleotides, lipids, hormones , vitamins and cells.

The pharmaceutical composition may also be present in combination with at least one pharmaceutically acceptable carrier. A carrier, also known in the art as an excipient, vehicle, adjuvant, adjuvant or diluent, is any substance that is pharmaceutically inert, imparts a suitable consistency or shape to the composition, and does not reduce the therapeutic efficacy of the compound. A carrier is "pharmaceutically or pharmacologically acceptable" if it does not cause an adverse, allergic, or other inappropriate reaction when administered to a mammal or suitably a human.

Pharmaceutical compositions containing a compound or steroid of the present disclosure may be formulated in any conventional manner. Proper formulation is dependent on the route of administration chosen. As long as the target tissue is available via any route of administration, the compositions of the present disclosure may be formulated for that route. Suitable routes of administration include oral, parenteral (eg, intravenous, intraarterial, subcutaneous, rectal, subcutaneous, intramuscular, intraorbital, intracapsular, intrathecal, intraperitoneal, or intrasternal), topical (nasal, transdermal). , intraocular), bladder, intrathecal, enteral, lung, intralymphatic, intracavitary, vaginal, transurethral, intradermal, ear, intramammary, buccal, orthotopic, intratracheal, intralesional, transdermal, endoscopic, transmucosal, sublingual and including, but not limited to, enteral administration. In certain embodiments, the route of administration is oral. In certain embodiments, the route of administration is parenteral. In certain embodiments, the route of administration is intravenous.

Pharmaceutically acceptable carriers for use in the compositions of the present disclosure are well known to those skilled in the art and include, for example: the particular compound employed, and its concentration, stability, and intended bioavailability; the disease, disorder or condition to be treated with the composition; the subject, its age, size, and general condition; and/or the route of administration. Suitable carriers can be readily determined by one of ordinary skill in the art. (See, e.g., J. G. Nairn, in: Remington's Pharmaceutical Science (A. Gennaro, ed.), Mack Publishing Co., Easton, Pa., (1985), pp.1492-1517.)

The compositions may be tablets, dispersible powders, pills, capsules, gelcaps, caplets, gels, liposomes, granules, solutions, suspensions, emulsions, syrups, elixirs, troches, dragees, lozenges or any other that can be administered orally. It may be formulated as a dosage form. Techniques and compositions for preparing oral dosage forms useful in the present disclosure are described in the following exemplary references: 7 Modern Pharmaceutics, Chapters 9 and 10 (Banker & Rhodes, Editors, 1979); Lieberman et al., Pharmaceutical Dosage Forms: Tablets (1981); and, Ansel, Introduction to Pharmaceutical Dosage Forms 2nd Edition (1976).

Compositions of the present disclosure designed for oral administration include an effective amount of a compound of the present disclosure in a pharmaceutically acceptable carrier. Suitable carriers for solid dosage forms are sugar, starch, and lactose, talc, sucrose, gelatin, carboxymethylcellulose, agar, mannitol, sorbitol, calcium phosphate, calcium carbonate, sodium carbonate, kaolin, alginic acid, acacia, corn starch, potato starch , sodium saccharin, magnesium carbonate, tragacanth, microcrystalline cellulose, colloidal silicon dioxide, croscarmellose sodium, talc, magnesium stearate, and stearic acid. In addition, such solid dosage forms may be uncoated or may be coated by known techniques (eg to delay disintegration and absorption).

The compounds, steroids and prodrugs of the present disclosure may also be formulated for parenteral administration (e.g., intravenous, intraarterial, subcutaneous, rectal, subcutaneous, intramuscular, intraorbital, intracapsular, intrathecal, formulated for injection via the intraperitoneal or intrasternal route). Compositions of the present disclosure for parenteral administration include an effective amount of a compound in a pharmaceutically acceptable carrier. Dosage forms suitable for parenteral administration include solutions, suspensions, dispersions, emulsions or any other dosage form that can be administered parenterally. Techniques and compositions for preparing parenteral dosage forms are known in the art. Typically, formulations for parenteral administration are sterile or are sterile prior to administration.

Suitable carriers used in formulating liquid dosage forms for oral or parenteral administration include non-aqueous, pharmaceutically acceptable polar solvents such as oils, alcohols, amides, esters, ethers, ketones, hydrocarbons and mixtures thereof, as well as water; saline solution, dextrose solution (eg DW5), electrolyte solution or any other aqueous, pharmaceutically acceptable liquid.

Suitable non-aqueous, pharmaceutically acceptable polar solvents include alcohols (eg, α-glycerol formal, β-glycerol formal, 1,3-butylene glycol, aliphatic or aromatic alcohols having 2-30 carbon atoms; such as methanol, ethanol, propanol, isopropanol, butanol, t-butanol, hexanol, octanol, amylene hydrate, benzyl alcohol, glycerin (glycerol), glycol, hexylene glycol, tetrahydrofurfuryl alcohol, lauryl alcohol, cetyl alcohols, or stearyl alcohol, fatty alcohols such as fatty acid esters of polyalkylene glycols (eg polypropylene glycol, polyethylene glycol), sorbitan, sucrose and cholesterol); Amides (eg dimethylacetamide (DMA), benzyl benzoate DMA, dimethylformamide, N-(β-hydroxyethyl)-lactamide, N,N-dimethylacetamide, 2-pyrrolidinone, 1 -methyl-2-pyrrolidinone or polyvinylpyrrolidone); esters (eg, 1-methyl-2-pyrrolidinone, 2-pyrrolidinone, acetate esters such as monoacetin, diacetin, and triacetin, aliphatic or aromatic esters such as ethyl caprylate or octano ate, alkyl oleate, benzyl benzoate, benzyl acetate, dimethylsulfoxide (DMSO), glycerin esters such as mono, di, or tri-glyceryl citrate or tartrate, ethyl benzoate, ethyl acetate, ethyl carbonate , ethyl lactate, ethyl oleate, sorbitan fatty acid esters, fatty acid derived PEG esters, glyceryl monostearate, glyceride esters such as mono, di, or tri-glycerides, fatty acid esters such as isopropyl myristate, fatty acid derived PEG Esters such as PEG-hydroxyoleate and PEG-hydroxystearate, N-methyl pyrrolidinone, pluronic 60, polyoxyethylene sorbitol oleic acid polyesters such as poly(ethoxylated)30-60 sorbitol poly(oleate) ate)2-4, poly(oxyethylene)15-20 monooleate, poly(oxyethylene)15-20 mono 12-hydroxystearate, and poly(oxyethylene)15-20 mono-ricinoleate, poly oxyethylene sorbitan esters (such as polyoxyethylene-sorbitan monooleate, polyoxyethylene-sorbitan monopalmitate, polyoxyethylene-sorbitan monolaurate, polyoxyethylene-sorbitan monostearate, and ICI America Polysorbate® 20, 40, 60 or 80 from ICI Americas (Wilmington, Del.), polyvinylpyrrolidone, alkyleneoxy modified fatty acid esters (such as polyoxyl 40 hydrogenated castor oil) , cyclodextrins or modified cyclodextrins (eg, beta-hydroxypropyl-cyclodextrin), saccharide fatty acid esters (ie, condensation products of monosaccharides (eg, pentose, such as ribose, ribulose) , arabinose, xylose, lyxose and xylulose, hexoses such as glucose, fructose Toses, galactose, mannose and sorbose, triose, tetros, heptose, and octose), disaccharides (e.g., sucrose, maltose, lactose and trehalose) or oligosaccharides or C4-C22 fatty acids (s) (e.g., saturated fatty acids such as caprylic acid, capric acid, lauric acid, myristic acid, palmitic acid and stearic acid, and unsaturated fatty acids such as palmitoleic acid, oleic acid, elaidic acid, erucic acid and linoleic acid)), or steroidal esters); alkyl, aryl or cyclic ethers having 2-30 carbon atoms (eg diethyl ether, tetrahydrofuran, dimethyl isosorbide, diethylene glycol monoethyl ether); glycofurol (tetrahydrofurfuryl alcohol polyethylene glycol ether); ketones having 3-30 carbon atoms (eg, acetone, methyl ethyl ketone, methyl isobutyl ketone); Aliphatic, cycloaliphatic or aromatic hydrocarbons having 4-30 carbon atoms (eg, benzene, cyclohexane, dichloromethane, dioxolane, hexane, n-decane, n-dodecane, n-hexane, sulfolane, tetra methylenesulfone, tetramethylenesulfoxide, toluene, dimethylsulfoxide (DMSO) or tetramethylenesulfoxide); Oils of mineral, vegetable, animal, essential or synthetic origin (e.g., mineral oils such as aliphatic or waxy hydrocarbons, aromatic hydrocarbons, mixed aliphatic and aromatic hydrocarbons, and refined paraffinic oils, vegetable oils such as linseed, oil , safflower, soybean, castor, cottonseed, peanut, rapeseed, coconut, palm, olive, corn, corn pear, sesame, persic and peanut oils and glycerides such as mono-, di- or triglycerides, animal oils such as fish oil, marine oil, light oil, cod-liver oil, hallibur, squalene, squalane, and shark liver oil, oleic acid oil, and polyoxyethylated castor oil); alkyl or aryl halides having 1-30 carbon atoms and optionally more than one halogen substituent; methylene chloride; monoethanolamine; petroleum benzine; trolamine; omega-3 polyunsaturated fatty acids (eg, alpha-linolenic acid, eicosapentaenoic acid, docosapentaenoic acid or docosahexaenoic acid); polyglycol esters of 12-hydroxystearic acid and polyethylene glycol (Solutol® HS-15 from BASF, Ludwigshafen, Germany); polyoxyethylene glycerol; sodium laurate; sodium oleate; or sorbitan monooleate.

Other pharmaceutically acceptable solvents for use in the present disclosure are well known to those skilled in the art and are described in The Handbook of Pharmaceutical Excipients, (American Pharmaceutical Association, Washington, DC, and The Pharmaceutical Society of Great Britain, London, England, 1968), Modern Pharmaceutics, (G. Banker et al., eds., 3d ed.) (Marcel Dekker, Inc., New York, NY, 1995), The Pharmacological Basis of Therapeutics, (Goodman & Gilman, McGraw Hill Publishing), Pharmaceutical Dosage Forms, (H. Lieberman et al., eds.,) (Marcel Dekker, Inc., New York, NY, 1980), Remington's Pharmaceutical Sciences (A. Gennaro, ed., 19th ed.) (Mack Publishing, Easton, Pa., 1995), The United States Pharmacopeia 24, The National Formulary 19, (National Publishing, Philadelphia, Pa., 2000), AJ Spiegel et al., and Use of Nonaqueous Solvents in Parenteral Products, J. of Pharm. Sciences, Vol. 52, No. 10, pp. 917-927 (1963)].

Preferred solvents are cyclodextrins or modified cyclodextrins (eg, beta-hydroxypropyl-cyclodextrin) as well as triglyceride-rich oils such as safflower oil, soybean oil or mixtures thereof, and alkyleneoxy modified fatty acid esters such as polyoxyl 40 hydrogenated castor oil. Commercially available triglycerides include Intralipid® emulsified soybean oil (Kabi-Pharmacia Inc., Stockholm, Sweden), Nutralipid® emulsion (McGaw, Irvine, CA). ), Liposyn® II 20% emulsion (20% fat emulsion solution containing 100 mg safflower oil, 100 mg soybean oil, 12 mg egg yolk phosphatide and 25 mg glycerin per ml of solution; Abbott Laboratories (Abbott Laboratories, Chicago, IL), Liposine® III 2% emulsion (2% fat emulsion solution containing 100 mg safflower oil, 100 mg soy oil, 12 mg egg yolk phosphatide and 25 mg glycerin per ml of solution; Abbott Laboratories, Chicago, IL), natural or synthetic glycerol derivatives containing docosahexaenoyl groups at levels of 25% to 100% by weight, based on total fatty acid content (Dhasco® (Martek Bio) Martek Biosciences Corp., Columbia, MD), DHA Maguro® (Daito Enterprises, Los Angeles, CA), Soyacal®, and Trave Emulsion (Travelmulsion)®.

Additional minor ingredients may be included in the compositions of the present disclosure for various purposes well known in the pharmaceutical art. These ingredients will, for the most part, impart properties such as enhancing the retention of the compound at the site of administration, protecting the stability of the composition, adjusting the pH, and facilitating processing of the compound into pharmaceutical formulations. Preferably, each of these components is individually present in less than about 15% by weight of the total composition, more preferably less than about 5% by weight, and most preferably less than about 0.5% by weight of the total composition. Some ingredients, such as fillers or diluents, may constitute up to 90% by weight of the total composition as is well known in the formulation art. Such additives include cryoprotectants, surfactants, wetting or emulsifying agents to prevent re-precipitation (e.g. lecithin, polysorbate-80, Tween® 80, Pluronic 60, polyoxyethylene stearate), preservatives (e.g. ethyl-p-hydroxybenzoate), microbial preservatives (e.g. benzyl alcohol, phenol, m-cresol, chlorobutanol, sorbic acid, thimerosal and parabens), pH adjusters or buffers ( For example, acids, bases, sodium acetate, sorbitan monolaurate), osmolarity adjusting agents (for example glycerin), thickeners (for example aluminum monostearate, stearic acid, cetyl alcohol, stearyl alcohol) , guar gum, methyl cellulose, hydroxypropylcellulose, tristearin, cetyl wax esters, polyethylene glycol), colorants, dyes, flow aids, non-volatile silicones (eg cyclomethicone), clays (eg, bentonite), adhesives, bulking agents, flavoring agents, sweetening agents, adsorbents, fillers (e.g., sugars such as lactose, sucrose, mannitol, or sorbitol, cellulose or calcium phosphate), diluents (e.g., water, saline, electrolyte solution), binders (e.g., starches such as corn starch, wheat starch, rice starch, or potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropyl methylcellulose, sodium carboxymethyl cellulose, polyvinylpi rolidone, sugar, polymer, acacia), disintegrant (eg, starch, such as corn starch, wheat starch, rice starch, potato starch, or carboxymethyl starch, cross-linked polyvinyl pyrrolidone, agar, alginic acid or salts thereof , such as sodium alginate, croscarmellose sodium or crospovidone), lubricants (eg silica, talc, stearic acid or salts thereof such as magnesium stearate or polyethylene glycol), coating agents (eg gum arabic, talc, Concentrated sugar solutions including polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, or titanium dioxide) and antioxidants (eg, sodium metabisulfite, sodium bisulfite) , sodium sulfite, dextrose, phenol and thiophenol).

Dosages from administration by these routes may be continuous or intermittent depending on, for example, the physiological condition of the patient, whether the purpose of administration is curative or prophylactic, and other factors known to the practitioner and which may be assessed.

In administering anesthetics, the skilled artisan will know how to titrate dosages and regimens for administration of the pharmaceutical compositions of the present disclosure, or effective dosages for use in treating insomnia, mood disorders, convulsive disorders, anxiety, or ethanol withdrawal symptoms. can be easily determined. It is understood that the dosage of the compound will depend on the age, sex, health and weight of the recipient, the type of concomitant treatment, if any, the frequency of treatment and the nature of the effect desired. For any mode of administration, the actual amount of compound delivered, as well as the dosing schedule necessary to achieve the beneficial effects described herein, will also depend, in part, on factors such as the bioavailability of the compound, the disorder being treated, the desired therapeutic dose, and usually will depend on other factors that the technologist will be aware of. The dose administered to an animal, particularly a human, in the context of the present disclosure should be sufficient to affect the desired therapeutic response in the animal over a reasonable period of time. Preferably, an effective amount of a compound, whether administered orally or by another route, is any amount that will produce the desired therapeutic response when administered by such route. The dosage may vary depending on the dosing schedule, which may be adjusted as necessary to achieve the desired therapeutic effect. The most preferred dosage will be tailored to the individual subject without undue experimentation in the sense that it can be understood and determined by one of ordinary skill in the art.

In one embodiment, solutions for oral administration are prepared by dissolving the compound in any pharmaceutically acceptable solvent capable of dissolving the compound (eg, ethanol or methylene chloride) to form a solution. An appropriate volume of carrier, a solution, such as beta-hydroxypropyl-cyclodextrin, is added to the solution while stirring to form a pharmaceutically acceptable solution for oral administration to a patient. If desired, such solutions can be formulated to contain minimal or no ethanol, which is known in the art to cause deleterious physiological effects when administered at certain concentrations in oral formulations.

In another embodiment, a powder or tablet for oral administration is prepared by dissolving the compound in any pharmaceutically acceptable solvent capable of dissolving the compound (eg, ethanol or methylene chloride) to form a solution. . The solvent may optionally be evaporated when the solution is dried under vacuum. Additional carriers such as beta-hydroxypropyl-cyclodextrin may be added to the solution prior to drying. The resulting solution is dried under vacuum to form a glass. The glass is then mixed with a binder to form a powder. The powder may be mixed with fillers or other conventional tabletting agents and processed to form tablets for oral administration to a patient. The powder may also be added to any liquid carrier as described above to form solutions, emulsions, suspensions, etc. for oral administration.

Emulsions for parenteral administration can be prepared by dissolving the compound in any pharmaceutically acceptable solvent capable of dissolving the compound (eg, ethanol or methylene chloride) to form a solution. An appropriate volume of carrier, which is an emulsion, such as a Lipocin® II or Lipocin® III emulsion, is added to the solution while stirring to form a pharmaceutically acceptable emulsion for parenteral administration to a patient.

Solutions for parenteral administration can be prepared by dissolving the compound in any pharmaceutically acceptable solvent capable of dissolving the compound (eg, ethanol or methylene chloride) to form a solution. An appropriate volume of carrier, which is a solution, such as beta-hydroxypropyl-cyclodextrin, is added to the solution while stirring to form a pharmaceutically acceptable solution for parenteral administration to a patient.

If desired, the emulsions or solutions described above for oral or parenteral administration may be packaged in a concentrated form in an IV bag, vial or other conventional container, which may be prepared at an acceptable concentration prior to use as is known in the art. can be diluted with any pharmaceutically acceptable liquid, such as saline, to form

Further kits (eg, pharmaceutical packs) are encompassed by the present invention. A provided kit may include a compound as described herein and a container (eg, a vial, ampule, bottle, syringe and/or dispenser package or other suitable container). In some embodiments, provided kits can optionally further comprise a second container comprising a pharmaceutical carrier for diluting or suspending the pharmaceutical composition or compound. In some embodiments, the pharmaceutical composition or compound provided in the container and the second container are combined to form one unit dosage form.

Optionally, instructions for use are further provided in such kits of the invention. Such instructions may generally provide instructions for, for example, dosage and administration. In other embodiments, the instructions may further provide additional details regarding specialized instructions for a particular container and/or system for administration. Additionally, the instructions may provide specialized instructions for use in combination and/or combination with additional therapeutic agents.

4. Definition

As used herein, the term “steroid” describes an organic compound that contains a cyclopenta[a]phenanthrene ring system at its chemical center.

As used herein, the term "pharmaceutically acceptable salt" is suitable for use in contact with tissues of humans and lower animals without undue toxicity, irritation, allergic reaction, etc. within the scope of sound medical judgment and has a reasonable benefit/risk ratio. the corresponding salt. Pharmaceutically acceptable salts are well known in the art. For example, Berge et al. [J. Pharmaceutical Sciences, 1977, 66, 1-19 describe in detail pharmaceutically acceptable salts. Pharmaceutically acceptable salts of the compounds of the present invention include those derived from suitable inorganic and organic acids and bases. Examples of pharmaceutically acceptable, non-toxic acid addition salts are formed with inorganic acids such as hydrochloric acid, hydrobromic acid, phosphoric acid, sulfuric acid and perchloric acid or organic acids such as acetic acid, oxalic acid, maleic acid, tartaric acid, citric acid, succinic acid or malonic acid, or or salts of amino groups formed by using other methods used in the art, such as ion exchange. Other pharmaceutically acceptable salts include adipate, alginate, ascorbate, aspartate, benzenesulfonate, benzoate, bisulfate, borate, butyrate, camphorate, camphorsulfonate, citrate, cyclopentanepropio nate, digluconate, dodecylsulfate, ethanesulfonate, formate, fumarate, glucoheptonate, glycerophosphate, gluconate, hemisulphate, heptanoate, hexanoate, hydroiodide, 2- Hydroxy-ethanesulfonate, lactobionate, lactate, laurate, lauryl sulfate, maleate, maleate, malonate, methanesulfonate, 2-naphthalenesulfonate, nicotinate, nitrate, oleate , oxalate, palmitate, pamoate, pectinate, persulfate, 3-phenylpropionate, phosphate, picrate, pivalate, propionate, stearate, succinate, sulfate, tartrate, thiocyanate , p-toluenesulfonate, undecanoate, valerate salts and the like. Salts derived from suitable bases include alkali metal, alkaline earth metal, ammonium and N+(C1-4alkyl)4 salts. Representative alkali or alkaline earth metal salts include sodium, lithium, potassium, calcium, magnesium, and the like. Further pharmaceutically acceptable salts include, where appropriate, non-toxic ammonium, quaternary ammonium, and counterions such as halides, hydroxides, carboxylates, sulfates, phosphates, nitrates, lower alkyl sulfonates and aryls. amine cations formed using sulfonates.

As used herein, the term “prodrug” describes a pharmacological agent that is administered in a less active or inactive form. Following administration, the prodrug is metabolized in vivo, for example, through hydrolysis, oxidation, or a reaction under biological conditions (in vitro or in vivo) to provide the active metabolite. See, eg, Wu, Pharmaceuticals (2009) 2:77-81. In certain embodiments, the prodrug has improved physical and/or delivery properties over the parent compound. Prodrugs are typically designed to enhance pharmaceutically and/or pharmacokinetically based properties associated with the parent compound. The advantage of a prodrug may lie in its physical properties, such as enhanced aqueous solubility for parenteral administration at physiological pH compared to the parent compound, or it may enhance absorption from the digestive tract or skin, or it may facilitate long-term storage. may improve drug stability for

As used herein, a "subject" contemplated for administration is a mammal, e.g., a human (i.e., a male or female of any age, e.g., a pediatric subject (e.g., infant, adolescent) or adult subject (e.g., (e.g., young adults, middle-aged adults, or elderly adults)), other primates (e.g., cynomolgus monkeys, rhesus monkeys) and commercially suitable mammals such as cattle, pigs, horses, sheep, goats, cats, and/or dogs. In any aspect and/or embodiment of the invention, the subject is a human.

As used herein, “therapeutically effective amount”, “sufficient amount” or “sufficient amount” of a compound refers to the level, amount or concentration of the compound required for a desired biological response, eg, analgesia.

As used herein, the term “saturated” describes a state in which all available valence bonds of an atom (especially carbon) are attached to other atoms.

As used herein, the term “unsaturated” describes a condition in which all available valence bonds along the alkyl chain are not satisfied; Extra bonds in these compounds usually form double or triple bonds (usually with carbon).

When a numerical range is recited, it is intended to encompass each numerical value and sub-range within the range. For example, “C1-4 alkyl” is intended to encompass C1, C2, C3, C4, C1-3, C1-2, C2-4, C2-3 and C3-4 alkyl, and “C1-22 "Alkyl" means, for example, C1, C2, C3, C4, etc., as well as C1-21, C1-20, C1-15, C1-10, C2-20, C2-15, C2-10, C3-15, C3 It is intended to encompass alkyls such as -10.

As used herein, “alkyl” is straight chain or branched having 1 to 4 carbon atoms (“C1-4 alkyl”) in some embodiments and 1 to 22 carbon atoms (“C1-22 alkyl”) in other embodiments. Refers to a radical of a topographically saturated hydrocarbon group. In some embodiments, an alkyl group has 1 to 3 carbon atoms (“C1-3 alkyl”). In some embodiments, an alkyl group has 1 to 2 carbon atoms (“C1-2 alkyl”). In some embodiments, an alkyl group has 1 carbon atom (“C1 alkyl”). In some embodiments, an alkyl group has 2 to 4 carbon atoms (“C2-4 alkyl”). In another embodiment, an alkyl group has from 1 to 21 carbon atoms (“C1-21 alkyl”), from 1 to 20 carbon atoms (“C1-20 alkyl”), from 1 to 15 carbon atoms (“C1-15 alkyl”). "), 1 to 10 carbon atoms ("C1-10 alkyl"), and the like. Examples of such alkyl groups are methyl (C1), ethyl (C2), n-propyl (C3), isopropyl (C3), n-butyl (C4), tert-butyl (C4), sec-butyl (C4), iso-butyl (C4), pentyl (C5), and the like.

As used herein, “alkenyl” or “alkenyl” means in some embodiments 2 to 4 carbon atoms (“C2-4 alkenyl”) and in other embodiments 2 to 22 carbon atoms (“C2-22 alkenyl”). ), and a straight-chain or branched hydrocarbon group having at least one carbon-carbon double bond. In some embodiments, an alkenyl group has 2 to 3 carbon atoms (“C2-3 alkenyl”). In some embodiments, an alkenyl group has two carbon atoms (“C2 alkenyl”). In another embodiment, an alkenyl group has 2 to 21 carbon atoms ("C2-21 alkenyl"), 2 to 20 carbon atoms ("C2-20 alkenyl"), 2 to 15 carbon atoms ("C2 -15 alkenyl"), 2 to 10 carbon atoms ("C2-10 alkyl"), and the like. One or more carbon-carbon double bonds may be internal (eg at 2-butenyl) or terminal (eg at 1-butenyl). Examples of such alkenyl groups are ethenyl (C2), 1-propenyl (C3), 2-propenyl (C3), 1-butenyl (C4), 2-butenyl (C4), butadienyl (C4). ), 1-pentenyl (C5), 2-pentenyl (C5), and the like.

As used herein, “alkynyl” or “alkyne” refers to a radical of a straight-chain or branched hydrocarbon group having 2 to 4 carbon atoms and at least one carbon-carbon triple bond (“C2-10 alkynyl”) . In some embodiments, an alkynyl group has 2 to 3 carbon atoms (“C2-3 alkynyl”). In some embodiments, an alkynyl group has two carbon atoms (“C2 alkynyl”). One or more carbon-carbon triple bonds may be internal (eg, in 2-butynyl) or terminal (eg, in 1-butynyl). Examples of C2-4 alkynyl groups include, without limitation, ethynyl (C2), 1-propynyl (C3), 2-propynyl (C3), 1-butynyl (C4), 2-butynyl (C4) etc.

As used herein, “aryl” refers to a monocyclic or polycyclic (eg, bicyclic or tricyclic) 4n+2 aromatic ring having 6-14 ring carbon atoms and 0 heteroatoms provided within the aromatic ring system. refers to a radical of a system (eg, having 6, 10 or 14 electrons shared in a cyclic configuration) (“C6-14 aryl”). In some embodiments, an aryl group has 6 ring carbon atoms (“C6 aryl”; eg, phenyl). In some embodiments, an aryl group has 10 ring carbon atoms (“C10 aryl”; eg, naphthyl, such as 1-naphthyl and 2-naphthyl). In some embodiments, an aryl group has 14 ring carbon atoms (“C14 aryl”; eg, anthracyl).

“Alkoxy,” as used herein, refers to an alkyl, alkenyl or alkynyl group, as defined herein, attached to an oxygen radical.

Alkyl, alkenyl, alkynyl and aryl groups as defined herein are substituted or unsubstituted and are also referred to herein as “optionally substituted”. In general, the term "substituted", whether or not preceded by the term "optionally", means that at least one hydrogen present on a group (e.g., a carbon or nitrogen atom) is an acceptable substituent, e.g., upon substitution is meant to be replaced with a substituent that results in a stable compound, for example a compound that does not spontaneously undergo transformation, such as by rearrangement, cyclization, elimination or other reaction. Unless otherwise indicated, a "substituted" group has a substituent at one or more substitutable positions of the group, and when more than one position in any given structure is substituted, the substituent is the same or different at each position. The term “substituted” is intended to include substitution with all permissible substituents of organic compounds, with any substituents described herein that result in the formation of stable compounds. The present invention contemplates any and all such combinations to arrive at a stable compound. For the purposes of this invention, a heteroatom such as nitrogen may have a hydrogen substituent and/or any suitable substituent as described herein that satisfies the valence of the heteroatom and allows a stable moiety to be formed.

Exemplary substituents include heteroatoms (eg, nitrogen, oxygen, silicon, phosphorus, boron, sulfur, or halogen atoms), halogen (eg, chlorine, bromine, fluorine, or iodine), heterocycle, alkoxy, alkene oxy, alkynoxy, aryloxy, hydroxy, protected hydroxy, keto, acyl, acyloxy, nitro, amino, amido, nitro, cyano, thiol, ketal, acetal, ester and ether containing groups .

treatment method

Previous studies (see, e.g., Gee et al., European Journal of Pharmacology, 136:419-423 (1987)) have shown that the GABA receptor complex (GRC), rather than others, has been reported for certain 3α-hydroxylated steroids (see, for example, Gee et al., European Journal of Pharmacology, 136:419-423 (1987)). ) has been demonstrated to be several orders of magnitude more potent (see, e.g., Majewska et al., Science 232:1004-1007 (1986); Harrison et al., J Pharmacol. Exp. Ther. 241:346-353 (see, e.g., Majewska et al., Science 232:1004-1007 (1986); Harrison et al., J Pharmacol. Exp. Ther. 241:346-353 ( 1987)]. Majewska et al. and Harrison et al. teach that 3β-hydroxylated-5-reduced steroids can only have much lower levels of efficacy. Experimental data in vitro and in vivo now demonstrate that the high potency of these steroids makes them therapeutically useful in the modulation of brain excitability through GRC (see, e.g., Gee et al., European Journal of Pharmacology, 136:419-423 (1987); see Wieland et al., Psychopharmacology 118(l):65-71 (1995)).

Various synthetic steroids have also been prepared as neuroactive steroids. See, for example, U.S. Pat. No. 5,232,917, which discloses neuroactive steroid compounds useful for treating stress, anxiety, insomnia, seizure disorders, and mood disorders such as depression, which can be treated with GRC-activators, in a therapeutically beneficial manner. In addition, these steroids are distinct from other known sites of interaction (eg, barbiturates, benzodiazepines, and GABA) where these steroids have previously elicited therapeutically beneficial effects on stress, anxiety, sleep, mood disorders, and seizure disorders. It has been previously demonstrated that they interact at distinct sites on the GRC that are being developed (see, e.g., Gee, KW and Yamamura, HI, "Benzodiazepines and Barbiturates: Drugs for the Treatment of Anxiety, Insomnia and Seizure Disorders," in Central). Nervous System Disorders, Horvell, ed., Marcel-Dekker, New York (1985), pp. 123-147; Lloyd, KG and Morselli, PL, "Psychopharmacology of GABAergic Drugs," in Psychopharmacology: The Third Generation of Progress, HY Meltzer, ed., Raven Press, NY (1987), pp. 183-195; and Gee et al., European Journal of Pharmacology, 136:419-423 (1987)). These compounds are preferred for their duration, potency and oral activity (as with other dosage forms).

The compounds of the invention as described above are generally designed to act as neuroactive steroids for the treatment and prevention of CNS-related conditions in a subject by modulating GABA function. Modulation, as used herein, refers to inhibition or enhancement of GABA receptor function. Accordingly, the compounds and pharmaceutical compositions provided herein find use as therapeutic agents for preventing and/or treating CNS conditions in mammals, including humans and non-human mammals. Accordingly, and as mentioned above, the present invention includes within its scope and extends to the methods of treatment mentioned, as well as compounds for such methods, and the use of such compounds for the manufacture of medicaments useful for such methods.

In one embodiment, disclosed herein is a method of treating a condition associated with GABAA receptor modulation by administering to a subject an effective amount of a compound described herein. Exemplary conditions associated with GABAA receptor modulation include (a) sleep disorders [e.g., insomnia and REM sleep behavior disorders], epilepsy [e.g., epilepsy persistence, monogenic forms of epilepsy (e.g., Dravet syndrome) ), Lennox-Gastaut syndrome, infantile twitching, myoclonic epilepsy in children, acute recurrent seizures, febrile seizures], movement disorders [e.g. Huntington's disease, Parkinson's disease, cerebellar ataxia, Friedrich ataxia, ankylosing-human syndrome, dystonia, Tourette's syndrome, essential tremor], traumatic brain injury, pain disorders [e.g., neuropathic pain, injury-related chronic pain, acute pain, migraine headache, migraine persistence], vascular disorders [e.g. , stroke, ischemia, vascular malformation sequelae], neurodegenerative disorders [eg, Alzheimer's disease, Lewy body dementia, frontotemporal dementia, multiple system atrophy, multiple infarct dementia] and neurological disorders including tinnitus; (b) schizophrenia and schizoaffective disorder, mood disorders [e.g., depression, dysthymic disorder, bipolar disorder, anxiety disorders (e.g., generalized anxiety disorder, social anxiety disorder, phobias, obsessive compulsive disorder, panic disorder, trauma) post stress disorder), stress], cognitive disorders [e.g., attention deficit hyperactivity disorder], personality disorders [e.g., antisocial personality disorder, obsessive-compulsive personality disorder], autism spectrum disorders [e.g., idiopathic autism, single autism of genetic origin (e.g., Rett syndrome, tuberous sclerosis complex, Glazed X syndrome, Angelman's syndrome)] and substance abuse disorders [e.g., opiate addiction, stimulant addiction (e.g., cocaine addiction); alcoholism]; (c) women's health disorders, including postpartum depression, postpartum dysphoric disorder, polycystic ovary syndrome, menstrual epilepsy, preterm labor, preeclampsia, eclampsia, premenstrual and menstrual migraine; (d) inflammatory disorders including multiple sclerosis, asthma and rheumatoid arthritis; (e) Anesthesiological indications including, but not limited to, the full spectrum of sedation, including mild sedation/anxiolysis, moderate/procedural sedation, supervised anesthesia management, deep sedation, and general anesthesia.

In another aspect, there is provided a method of treating or preventing brain excitability in a subject suspected of having or having a condition associated with brain excitability, comprising administering to the subject an effective amount of a compound of the present invention.

In another aspect, there is provided a method of treating or preventing stress or anxiety in a subject comprising administering to the subject in need thereof an effective amount of a compound of the invention or a composition thereof.

In another aspect, there is provided a method of alleviating or preventing seizure activity in a subject comprising administering to the subject in need thereof an effective amount of a compound of the invention.

In another aspect, there is provided a method of alleviating or preventing insomnia in a subject comprising administering to the subject in need thereof an effective amount of a compound of the present invention or a composition thereof.

In another aspect, there is provided a method of inducing sleep and substantially maintaining the REM sleep levels found in normal sleep, comprising administering an effective amount of a compound of the invention, wherein no substantial rebound insomnia is induced.

In another aspect, there is provided a method of alleviating or preventing PMS or PND in a subject comprising administering to the subject in need thereof an effective amount of a compound of the invention.

In another aspect, there is provided a method of treating or preventing a mood disorder in a subject comprising administering to the subject in need thereof an effective amount of a compound of the present invention. In certain embodiments the mood disorder is depression.

In another aspect, there is provided a method of inducing anesthesia in a subject comprising administering to the subject an effective amount of a compound of the present invention.

In another aspect, there is provided a method of treating cognitive enhancement or memory impairment by administering to a subject a therapeutically effective amount of a compound of the invention. In certain embodiments, the disorder is Alzheimer's disease. In certain embodiments, the disorder is Rett's syndrome.

In another aspect, there is provided a method of treating attention disorder by administering to a subject a therapeutically effective amount of a compound of the invention. In certain embodiments, the attention disorder is ADHD.

In another aspect, a combination of a compound of the present invention and another pharmacologically active agent is provided. A compound provided herein can be administered as a single agent, or can be administered in combination with other agents. Combination administration may proceed by any technique apparent to those skilled in the art, including, for example, individual, sequential, conjoint and alternating administration.

In certain embodiments, the compound is administered to the subject chronically. In certain embodiments, the compound is administered to the subject orally, subcutaneously, intramuscularly, or intravenously.

anesthesia / sedation

Anesthesia is a pharmacologically induced and reversible state in which amnesia, analgesia, loss of reactivity, loss of skeletal muscle reflexes, reduced stress response, or both are simultaneously pharmacologically induced. These effects can be obtained from a single drug alone that provides the exact combination of effects, or sometimes with a combination of drugs (e.g., hypnotics, sedatives, numbing agents, analgesics) to achieve a very specific combination of results. can be obtained. Anesthesia allows patients to undergo surgery and other procedures without the discomfort and pain that they would otherwise experience.

Sedation is the reduction of irritability or agitation by administration of a pharmacological agent, generally to facilitate a medical or diagnostic procedure.

Sedation and analgesia include a sequence of states of consciousness ranging from minimal sedation (anxiolysis) to general anesthesia.

Minimal sedation is also known as anxiolysis. Minimal sedation is a drug-induced state during which the patient responds normally to verbal commands. Cognitive function and coordination can be impaired. Ventilation and cardiovascular functions are not affected.

Moderate sedation/analgesia (subconscious sedation) is a drug-induced decrease in consciousness during which the patient responds purposefully to verbal commands, either alone or involving mild tactile stimuli. No intervention is required to maintain an open airway. Spontaneous ventilation is sufficient. Cardiovascular function is normally maintained.

Deep sedation/analgesia is a drug-induced decrease in consciousness, during which the patient cannot arouse easily but responds purposefully (not the escape reflex from the painful stimulus) to repetitive or painful stimuli. Independent ventilation may be impaired. The patient may require assistance to maintain an open airway. Spontaneous ventilation may be insufficient. Cardiovascular function is normally maintained.

General anesthesia is a drug-induced loss of consciousness, during which the patient is unable to arouse even to painful stimuli. The ability to maintain independent ventilation is often impaired. Help is often required to maintain an open airway. Positive pressure ventilation may be required due to decreased spontaneous ventilation or drug-induced decline in neuromuscular function. Cardiovascular function may be impaired.

Sedation in the intensive care unit (ICU) allows for a decrease in a patient's awareness of the environment and a decrease in his or her response to external stimuli. It plays a pivotal role in the management of critically ill patients and encompasses a broad spectrum of symptom control that varies from patient to patient and from individual to individual during their disease course. Excessive sedation in critical care management has been used, often with neuromuscular blockers, to facilitate endotracheal tube resistance and ventilation synchronization.

In some embodiments, sedation (eg, prolonged sedation, continuous sedation) is administered in the ICU for a long period of time (eg, 1 day, 2 days, 3 days, 5 days, 1 week, 2 weeks, 3 weeks, 1 month, 2 months) is induced and maintained. Long-term sedatives may have a long duration of action. Sedatives in the ICU may have a short elimination half-life.

Procedural sedation and analgesia, also referred to as conscious sedation, is a technique in which a sedative or dissociative agent is administered in the presence or absence of an analgesic to induce a condition in which the subject tolerates an unpleasant procedure while maintaining deep breathing function.

anxiety disorder

Anxiety disorder is an umbrella term that encompasses many different forms of abnormal and pathological fears and anxiety. Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders.

Generalized anxiety disorder is a common chronic disorder characterized by long-lasting anxiety, inability to focus on one purpose or situation. Patients with generalized anxiety experience non-specific persistent fears and concerns, and become overly concerned about everyday matters. Generalized anxiety disorder is the most common anxiety disorder affecting the elderly.

In panic disorder, a person suffers from brief attacks of strong fear and anxiety, often marked by tremors, agitation, confusion, dizziness, nausea, and difficulty breathing. These panic attacks, defined by the APA as a fear or malaise that occur suddenly and culminate within less than 10 minutes, can last for hours and can be triggered by stress, fear or even exercise; The specific cause is not always clear. In addition to recurrent and unexpected panic attacks, the diagnosis of panic disorder also requires that the seizures have chronic consequences, such as: concern for potential hints of seizures, persistent fear of future attacks, or in behavior associated with seizures. significant change. Thus, patients with panic disorder experience symptoms that are far beyond the specific panic episode. Often, a normal change in heartbeat is noticed by a panic patient, which makes the patient think that there is something wrong with his heart or that he will have another panic attack. In some cases, elevated arousal (hyperalertia) of bodily functions occurs during panic attacks, and any perceived physiological change translates into a possible life-threatening illness (ie, extreme psychosis).

Obsessive-compulsive disorder is a type of anxiety disorder characterized primarily by repetitive obsessions (painful, persistent and intrusive thoughts or images) and compulsions (a desire to perform a specific action or ritual). OCD thought patterns can be likened to superstitions insofar as they involve beliefs in causal relationships that do not actually exist. Often the process is entirely illogical; For example, the compulsive behavior of walking in a specific pattern may be used to alleviate the obsession with impending harm. And, in most cases, the compulsions are completely inexplicable, simply the desire to complete consciousness triggered by nervousness. In a few cases, patients with OCD may experience only obsessions without any overt compulsions; Very few patients experience only compulsions.

The single largest category of anxiety disorders is the phobia category, which includes all instances of fear and anxiety triggered by a specific stimulus or situation. A patient typically anticipates distressing consequences from facing the object of his fear, which can be anything from an animal to a place to a body fluid.

Post-traumatic stress disorder or PTSD is an anxiety disorder arising from traumatic experiences. Post-traumatic stress can arise from extreme situations such as fighting, rape, hostage play or even a serious accident. It can also result from long-term (chronic) exposure to severe stressors, for example, soldiers who can withstand individual battles but cannot respond to a series of fights. Common symptoms include recall, avoidant behavior, and depression.

Neurodegenerative diseases and disorders

The term “neurodegenerative disease” includes diseases and disorders associated with the progressive loss of structure or function of neurons or death of neurons. Neurodegenerative diseases and disorders include Alzheimer's disease (including symptoms associated with mild, moderate or severe cognitive impairment); amyotrophic lateral sclerosis (ALS); anaerobic and ischemic injury; ataxia and convulsions (including cases in the treatment and prevention of seizures caused by schizoaffective disorder or by drugs used to treat schizophrenia); benign forgetfulness; brain edema; cerebellar ataxia, including McLeod's neurostimulatory polycythemia (MLS); obstructive head injury; coma; contusion injuries (eg, spinal cord injuries and head injuries); dementia, including multi-infarct dementia and senile dementia; disturbance of consciousness; down syndrome; drug-induced or drug-induced parkinsonism (such as neuroleptic-induced acute akathisia, acute dystonia, parkinsonism, or tardive dyskinesia, neuroleptic malignant syndrome, or drug-induced postural tremor); epilepsy; Glazed X Syndrome; Gilles de la Tourette syndrome; head trauma; hearing impairment and loss; Huntington's disease; Lennox syndrome; levodopa-induced dyskinesia; mental retardation; movement disorders (including basal ganglion calcifications, cortical basal degeneration, multiple system atrophy, Parkinsonism-ALS dementia complex, Parkinson's disease, post-encephalitis parkinsonism, and progressive supranuclear palsy), including akinesia and akinetic (spastic) syndrome; Disorders associated with muscle spasms, and muscle stiffness or weakness, such as chorea (such as benign hereditary chorea, drug-induced chorea, unilateral ballism, Huntington's disease, neuroschirocytosis, sidenam chorea, and symptomatic chorea), dyskinesia (including tics such as complex tics, simple tics, and symptomatic tics), myoclonus (including generalized and focal myoclonus), tremors (such as resting tremors, postural tremors, and intentional tremors) and abnormalities catatonia (including axial dystonia, dystonia, hemiplegic dystonia, paroxysmal dystonia, and focal dystonia such as blepharospasm, mandibular dystonia, and twitch dysphonia and torticollis); neuronal damage including eye damage, retinopathy or macular degeneration of the eye; neurotoxic damage after stroke, thromboembolic stroke, hemorrhagic stroke, cerebral ischemia, cerebral vasospasm, hypoglycemia, amnesia, hypoxia, anoxia, perinatal asphyxia and cardiac arrest; Parkinson's disease; seizure; epilepsy persistence; apoplexy; tinnitus; tubular sclerosis, and viral infection-induced neurodegeneration (eg, caused by acquired immunodeficiency syndrome (AIDS) and encephalopathy). Neurodegenerative disorders also include, but are not limited to, neurotoxic damage following stroke, thromboembolic stroke, hemorrhagic stroke, cerebral ischemia, cerebral vasospasm, hypoglycemia, amnesia, hypoxia, anoxia, perinatal asphyxiation and cardiac arrest. does not Methods of treating or preventing a neurodegenerative disease also include treating or preventing loss of neuronal functional properties in a neurodegenerative disorder.

epilepsy

Epilepsy is a brain disorder characterized by recurrent seizures over time. Types of epilepsy include systemic epilepsy, such as childhood absence epilepsy, myoclonic epilepsy in children, epilepsy with grand seizures on awakening, West syndrome, Lennox-Gastaut syndrome, partial epilepsy, such as temporal lobe epilepsy, frontal lobe epilepsy, pediatric benign focal epilepsy.

Epilepsy persistence (SE)

Status epilepticus (SE) includes, for example, convulsive status epilepticus, eg, early status epilepticus, established status epilepticus, refractory status epilepticus, super-refractory status epilepticus; non-convulsive status epilepticus, eg, generalized status epilepticus, complex partial status epilepticus; whole-body periodic epileptic EEG; and periodic unilateral stromal EEG. Convulsive status epilepticus is characterized by the presence of convulsive status epileptic seizures and can include early status epilepticus, established status epilepticus, refractory status epilepticus, and hyper-refractory status epilepticus. Early status epilepticus is treated with first-line therapy. Established status epilepticus is characterized by status epileptic seizures that persist despite treatment with first-line therapy, and second-line therapy is administered. Refractory status epilepticus is characterized by status epileptic seizures that persist despite treatment with first-line and second-line therapies, and general anesthesia is usually administered. Ultra-refractory status epilepticus is characterized by persistent status epileptic seizures that persist despite treatment with first-line therapy, second-line therapy, and general anesthesia for at least 24 hours.

Non-convulsive status epilepticus includes, for example, focal non-convulsive status epilepticus, eg, complex partial non-convulsive status epilepticus, simple partial non-convulsive status epilepticus, atypical non-convulsive status epilepticus; generalized non-convulsive status epilepticus, eg, late onset absent absence non-convulsive status epilepticus, atypical absence non-convulsive status epilepticus, or atypical absence non-convulsive status epilepticus.

The compositions described herein can also be used for CNS disorders prior to onset of seizures, e.g., traumatic brain injury, status epilepticus, e.g., convulsive status epilepticus, e.g., early status epilepticus, established status epilepticus, refractory status epilepticus status, hyper-refractory epilepsy persistence; non-convulsive status epilepticus, eg, generalized status epilepticus, complex partial status epilepticus; whole-body periodic epileptic EEG; and as a prophylactic to a subject having a periodic unilateral epileptic brain wave.

seizure

A seizure is a physical finding or change in behavior that occurs after an episode of abnormal electrical activity in the brain. The term “seizure” is often used interchangeably with “convulsions”. A convulsions is when a person's body shakes rapidly and uncontrollably. During a cramp, a person's muscles contract and relax repeatedly.

Based on the type of behavior and brain activity, seizures fall into two broad categories: systemic and partial (also called local or local). Classifying the type of seizure helps doctors diagnose whether a patient has epilepsy or not.

Generalized seizures are caused by electrical impulses from all over the brain, while partial seizures are (at least initially) caused by electrical impulses in a relatively small part of the brain. The part of the brain that produces a seizure is sometimes called the epicenter.

There are six types of generalized seizures. The most common and dramatic, and therefore the most widely known, are generalized convulsions, also called grand seizures. In this type of seizure, the patient loses consciousness and usually collapses. Loss of consciousness is followed by generalized rigidity (called the "tense" phase of the seizure) for 30 to 60 seconds, followed by intense tremors ("clonic" phase) for 30 to 60 seconds, after which the patient falls into a deep sleep ("seizure" phase). after" or seizure-late stage). During a grand seizure, injuries and accidents such as erectile walls and incontinence may occur.

Absence seizures cause short-term loss of consciousness (only a few seconds) with few or no symptoms. Patients, most often pediatric, typically cease activity and stare blankly. These seizures start and end abruptly, and may occur several times a day. Patients are usually unaware of having seizures, except that they may perceive "wasting time."

Myoclonic seizures usually consist of sporadic tremors on both sides of the body. Patients sometimes describe the tremors as brief electric shocks. In severe cases, these seizures can cause objects to be dropped or thrown unintentionally.

Myoclonic seizures are repetitive, periodic tremors involving both sides of the body at the same time.

Tonic seizures are characterized by muscle stiffness. Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, and often cause falls.

autism

Autism is a neurobehavioral development syndrome that occurs in infancy and consists of a combination of social deficits, limited verbal and/or non-verbal communication, and limited, repetitive, and stereotyped patterns of behavior, interests, or behaviors. Autism Spectrum Disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSMV) incorporates autism, Asperger's syndrome, pediatric disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS).

Autism develops before the age of 3 years. This means that there is a period of normal development followed by a period of regression.

Asperger's syndrome consists of social deficits and limited, repetitive and stereotyped interests, with or without cognitive delays in language development.

Childhood disintegrative disorder is a milder form of autistic regression that develops after 3 years of age.

PDD-NOS is characterized by milder symptoms than autism in only one domain (eg, social deficit).

Autism spectrum disorders may be idiopathic. However, there are many genetic causes of autism, including single gene mutations with a high degree of penetration [eg Rett syndrome, tuberous sclerosis complex, fragile X syndrome, Angelman syndrome]. In some cases, only gene mutations are used to refer to disease [eg, 22q13.3 deletion syndrome].

The present disclosure generally relates to neuroactive 19-alkoxy-17-substituted steroids as referred to herein for use, for example, as anesthetics and/or in the treatment of disorders related to GABA function and activity, and pharmaceutically acceptable thereof. It provides a salt that becomes

Example

The following examples describe or illustrate various embodiments of the present disclosure. Other embodiments within the scope of the appended claims will be apparent to those skilled in the art upon consideration of the practice of the disclosure as set forth in the specification or herein. It is intended that the specification together with the examples be regarded by way of example only, and that the scope and spirit of the disclosure is set forth by the claims following the examples.

A. Compound Chemistry

According to the following methods and examples, the following compounds are prepared for illustrative purposes:

<Scheme 1>

According to Scheme 1, the following compounds were prepared using methods generally known in the art and as outlined below.

19-[[(1,1-dimethyl)dimethylsilyl]oxy]-androst-4-ene-3,17-dione (1). Known 19-hydroxyandrostenedione (1 g, 3.31 mmol), tert-butyldimethylsilyl chloride (602 mg, 4 mmol), imidazole (315 mg, 4.63 mmol), DMF (5 mL) and methylene chloride ( 5 mL) was stirred at room temperature for 15 h. Water (100 mL) was added to the reaction mixture and extracted with methylene chloride (50 mL×3). The combined organic extracts were washed with brine, dried and concentrated to give a white solid. The solid was purified by flash column chromatography (silica gel eluted with 10-20% EtOAc in hexanes) to give a white solid (1.3 g, 94%):

(5α)-19-[[(dimethylethyl)dimethylsilyl]oxy]-androstan-3,17-dione (2). A small piece of lithium wire (140 mg, 20 mmol) was added to a cold stirred solution of freshly condensed liquid ammonia (-78° C.) (250 mL) and the mixture was stirred for 15 min. Steroid 1 (1.25 g, 3 mmol) in THF (75 mL) was added to the resulting dark blue solution and stirring was continued at -78°C for 2 h. Solid ammonium chloride (5 g) was added and the ammonia was allowed to evaporate. Water (200 mL) was added and the reaction mixture was extracted with EtOAc (100 mL×3). The combined EtOAc extracts were washed with brine, dried and concentrated to an oil. The oil was dissolved in stirring acetone (50 mL) and cooled in an ice bath. Jones reagent was added to the cold stirred solution until the orange color persisted for 1 hour. Excess Jones reagent was reduced by the addition of a few drops of isopropyl alcohol. Acetone was removed under reduced pressure and the resulting solution was diluted with water (200 mL) and extracted with EtOAc (80 mL×3). The combined EtOAc extracts were dried and removed to give a white solid, which was purified by chromatography (silica gel) to give Steroid 2 (830 mg, 63%):

(5α)-19-[[(dimethylethyl)dimethylsilyl]oxy]-androstan-3,17-dione, 3-cyclic 1,2-ethanediyl acetal (3). A solution of steroid 2 (4.6 g, 11.0 mmol) in benzene (-100 mL) containing ethylene glycol (5 mL) and PPTS (500 mg) was heated with a Dean-Stark apparatus at reflux for 4 h. The solvent was removed under reduced pressure and the residue was purified by column chromatography (silica gel eluted with 20% EtOAc in hexanes) to 3,17-bisketal (3.5 g) and steroid 3 (1.25) as a coagulated foam. g) was obtained:

(5α)-19-hydroxyandrostan-3,17-dione, 3-cyclic 1,2-ethanediyl acetal (4). To a solution of steroid 3 (1.0 g, 2.4 mmol) in THF (10 mL) at room temperature was added TBAF (6.0 mmol, 1.0 M in THF, 6.0 mL). The reaction mixture was refluxed for 16 h, the solvent was removed under reduced pressure, and the residue was purified by column chromatography (silica gel eluted with 30% EtOAc in hexanes) to give steroid 4 as an oil (638 mg, 84%). was obtained as:

(5α,17β)-17,17-dihydroxyandrostan-3-one, cyclic 1,2-ethanediyl acetal (5). To a solution of steroid 4 (635 mg, 1.8 mmol) in ethanol (40 mL) at room temperature was added sodium borohydride (152 mg, 4 mmol). After 3 h, the mixture was quenched with _{aqueous NH 4 Cl.} The mixture was extracted with EtOAc (50 mL×3), the organic layers were combined, _{dried over MgSO 4} , filtered and concentrated. The residue was purified by column chromatography (silica gel eluted with 35% EtOAc in hexanes) to give steroid 5 as an oil (638 mg, 100%):

(5α,17β)-17,19-dimethoxyandrostan-3-one, cyclic 1,2-ethanediyl acetal (6). To a solution of steroid 5 (635 mg, 1.8 mmol) in THF (30 mL) was added sodium hydride (400 mg, 60% in mineral oil, 6.0 mmol). After addition, the mixture was refluxed for 1 hour, iodomethane was added and refluxed for an additional 3 hours. After cooling to room temperature, the mixture was quenched with water and extracted with EtOAc (100 mL×3). The organic extracts were combined, _{dried over MgSO 4} , filtered and concentrated. The residue was purified by column chromatography (silica gel eluted with 20% EtOAc in hexanes) to give steroid 6 (623 mg, 92%):

(5α,17β)-17,19-dimethoxyandrostan-3-one (7, MQ-88). A mixture of steroid 6 (625 mg, 1.65 mmol), PTSA (100 mg), acetone (30 ml) and water (3 mL) was stirred at room temperature for 16 h. The solvent was removed by reduced pressure, aqueous NaHCO ₃ was added and the product was extracted with EtOAc (100 mL×3). The organic layers were combined, _{dried over MgSO 4} , filtered and concentrated. The residue was purified by column chromatography (silica gel eluted with 20% EtOAc in hexanes) to give steroid 7 (408 mg, 74%):

<Scheme 2>

(5α,17β)-17,19-dimethoxyandrostan-3-ol (8, MQ-89). To a solution of steroid 7 (200 mg, 0.60 mmol) in THF (10 mL) at -78°C was added K-selectride ® (1.0 mmol, 1.0 M in THF, 1.0 mL). After 2 h 3 N NaOH (10 mL) and H ₂ O ₂ (5 mL) were added at -78° C. and the reaction was allowed to warm to room temperature for 1 h. The product was extracted with EtOAc (100 mL×2) and washed with brine. The organic layers were combined, _{dried over MgSO 4} , filtered and concentrated. The residue was purified by column chromatography (silica gel eluted with 20% EtOAc in hexanes) to give steroid 8 (172 mg, 86%):

<Scheme 3>

(5α)-19-Methoxyandrostan-3,17-dione, cyclic bis-(1,2-ethanediyl acetal) (9). Known (5α)-19-hydroxyandrostan-3,17-dione, cyclic bis-(1,2-ethanediyl) acetal (430 mg, 1.1 mmol), NaH (200 mg, 5 mmol) and THF (10 mL) was heated under N ₂ at reflux for 2 h. The reaction mixture was cooled to room temperature, methyl iodide (2 mL, 32 mmol) was added and the mixture was stirred at room temperature for 13 h. The reaction mixture was cooled to 0° C. and excess NaH was carefully quenched by addition of MeOH (2 mL). Water (100 mL) was added and the product was extracted with EtOAc (80 mL×3). The combined organic extracts were washed with brine, dried and concentrated to give a colorless liquid. The crude product was purified by flash column chromatography (silica gel eluting with 15-20% EtOAc in hexanes) to give the product as a colorless liquid (440 mg, 99%):

(5α)-19-methoxyandrostan-3,17-dione (10). A mixture of steroid 9 (400 mg, 0.98 mmol), PTSA (100 mg), acetone (8 mL) and water (0.5 mL) was stirred at room temperature for 14 h. The reaction _{was neutralized with aqueous NaHCO 3} and the acetone was removed under reduced pressure. Water (80 mL) was added and the product was extracted with EtOAc (60 mL×3). The combined EtOAc extracts were dried and concentrated to give a white solid, which was purified by flash column chromatography (silica gel eluted with 20-30% EtOAc in hexanes) to give product 10 (230 mg, 73%). said:

(3α,5α)-3-hydroxy-19-methoxyandrostan-17-one (11, KK-125). A 1 M solution of K-Selectride® in THF (2 mL, 2 mmol, 3 equiv) was added to a cold solution (-78 °C) of steroid 10 (210 mg, 0.66 mmol) in THF (5 mL) and the reaction was stirred Stirred at -78°C for 1.5 hours. The reaction was quenched by the addition of a few drops of acetone and then allowed to warm to room temperature. 3 N aqueous NaOH (10 mL) was added followed by 30% aqueous H ₂ O ₂ (10 mL) and the reaction was stirred at room temperature for 1.5 h. The product was extracted with EtOAc (3 x 60 mL) and the combined EtOAc extracts were washed with brine, dried and concentrated to give an off-white solid which was subjected to flash column chromatography (silica gel with 20-40% EtOAc in hexanes). eluted). Product 11 (142 mg, 67%) was as follows:

(3α,5α,17β)-19-methoxyspiro[androstan-17,2′-oxiran]-3-ol (12, MQ-90). To a solution of steroid 11 (100 mg, 0.3 mmol) in DMF (10 mL) was added trimethylsulfonium iodide (306 mg, 1.5 mmol) and potassium tert-butoxide (168 mg, 1.5 mmol) at room temperature. The reaction was quenched with _{aqueous NH 4} Cl after 2 h. The mixture was extracted with dichloromethane (100 mL×2) and washed with brine. The organic layers were combined, _{dried over MgSO 4} , filtered and concentrated. The residue was purified by column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give steroid 12 (76 mg, 75%):

<Scheme 4>

(3α,5α)-19-methoxy-3-(methoxymethoxy)-androstan-17-one (13): in a solution of steroid 11 (800 mg, 2.5 mmol) in DCM (20 mL) at room temperature Chloromethyl methyl ether (302 mg, 3.75 mmol) and N,N-diisopropylethylamine (774 mg, 6 mmol) were added. The mixture was quenched with water after 16 h, extracted with EtOAc (100 mL×2) and washed with brine. The organic layer was _{dried over MgSO 4} , filtered and concentrated. The residue was purified by column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give the product 13 as an oil (900 mg, 100%):

(3α,5α)-19-methoxy-3-(methoxymethoxy)-androst-16-ene-17-carbonitrile (14): steroid 13 (800 mg, 2.5 mmol) in THF (20 mL) was added potassium bis(trimethylsilyl)amide (3.0 mmol, 0.5 M in toluene, 6.0 mL) at -78°C. After 30 min, N-phenyltrifluoromethanesulfonimide (1.07 g, 3.0 mmol) in 5 mL of THF was added at -78°C. After 2 h at −78° C., the mixture was quenched with water and extracted with EtOAc (50 mL×3). The combined organic layers were dried, filtered and concentrated. The residue was purified by flash chromatography (silica gel) to give the intermediate enol triflate (1.21 g, containing inseparable impurities). To enol triflate (1.21 g) in a 50 mL round flask at room temperature sodium cyanide (300 mg, 6.0 mmol), copper (I) iodide (120 mg, 0.6 mmol) and Pd(PPh ₃ ) ₄ (60 mg) was added. Acetonitrile (25 mL) was added and the mixture was refluxed for 3 h. The mixture was _{quenched with aqueous NH 4} Cl and extracted with EtOAc (50 mL×3). The combined organic layers were dried, filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 10% EtOAc in hexanes) to give product 14 as an oil (886 mg, containing inseparable impurities):

(3α,5α)-3-hydroxy-19-methoxyandrost-16-ene-17-carbonitrile (15, MQ-91): steroid 14 containing inseparable impurities in methanol (20 mL) (886 mg) was added 6 N HCl (15 ml) at room temperature. After 14 h, the mixture was extracted with dichloromethane (50 mL×2). The combined organic layers were dried, filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 30% EtOAc in hexanes) to give product 15 (480 mg, 58% yield from steroid 13):

(3α,5α,17β)-3-hydroxy-19-methoxyandrostan-17-carbonitrile (16, MQ-92): in a solution of steroid 15 (430 mg, 1.3 mmol) in EtOAc (30 mL) Pd/C (10%, 100 mg) was added. Hydrogenation was carried out under 7 atm H ₂ at room temperature for 3 hours. The mixture was filtered through celite and washed with EtOAc (100 mL). The solvent was removed and the residue was purified by flash column chromatography (silica gel eluted with 10% EtOAc in hexanes) to give the product 16 (415 mg, 96%):

(3α,5α)-3-hydroxy-19-methoxypregnan-20-one (17, MQ-93): In a solution of steroid 16 (360 mg, 1.09 mmol) in THF (20 mL) at room temperature Magnesium bromide (3.0 M, 2 mL, 6.0 mmol) was added. The mixture was then refluxed for 16 h, then allowed to cool to room temperature and quenched by addition of 6 N HCl. The product was extracted with dichloromethane (50 mL×3). The combined organic layers were dried, filtered and concentrated. ¹ H NMR of the crude product (300 mg, 79%) showed 17β (steroid 17) and 17α diastereomers in a ratio of 8 to 1 respectively. The crude product was purified by flash column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give pure product 17 (135 mg):

<Scheme 5>

(3α,5α)-3-(acetyloxy)-19-methoxypregnan-20-one (18): To a solution of steroid 17 (100 mg, 0.29 mmol) in pyridine (5 mL) at room temperature with acetic anhydride ( 51 mg, 0.5 mmol) and DMAP (5 mg) were added. The reaction mixture was quenched with water after 2 h and extracted with EtOAc (50 mL×2). The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 20% EtOAc in hexanes) to give the product 18 as an oil (112 mg, 100%):

(3α,5α)-3,21-bis(acetyloxy)-19-methoxylpregnan-20-one (19): steroid 18 (112 mg, 0.29 mmol) in benzene (10 mL) and methanol (0.5 mL) ) was added lead tetraacetate (513 mg, 1.15 mmol) and boron trifluoride ether complex (1 mL) at room temperature. After 3 h, water was added and the product was extracted with EtOAc (50 mL×2). The combined organic layers were _{dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give the product 19 as a foam (82 mg, 63%):

(3α,5α)-3,21-dihydroxy-19-methoxypregnan-20-one (20, MQ-98): potassium bicarbonate in a solution of steroid 19 (82 mg, 0.18 mmol) in methanol at room temperature (280 mg, 2.0 mmol) was added. The mixture was refluxed for 5 hours. Water was added and the product was extracted with EtOAc (50 mL×2). The combined organic layers were _{dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give the product 20 (22 mg, 37%):

<Scheme 6>

19-hydroxyandrost-5-ene-3,17-dione, 3-cyclic 1,2-ethanediyl acetal (21): known 19-hydroxyandrost-4-ene in benzene (100 mL) To a solution of -3,17-dione (1.0 g, 3.3 mmol) was added ethylene glycol (267 mg, 4.3 mmol) and PPTS (100 mg). The mixture was refluxed in a flask equipped with a Dean-Stark trap. After 4 h, the mixture was cooled to room temperature and the solvent was removed by reduced pressure. The residue was purified by flash column chromatography (silica gel eluted with 15% EtOAc in hexanes) to the known 19-hydroxyandrost-5-ene-3,17-dione, 3,17-bis(cy Click 1,2-ethanediyl acetal) (260 mg, 20%) and product 21 (450 mg, 39%) were obtained:

(17β)-17,19-dihydroxyandrost-5-en-3-one, 3-cyclic 1,2-ethanediyl acetal (22): steroid 21 (450 mg, 1.29) in ethanol (50 mL) mmol) was added sodium borohydride (152 mg, 4 mmol) at room temperature. After 3 h, aqueous NH ₄ Cl was added and the product was extracted with EtOAc (50 mL×3). The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 35% EtOAc in hexanes) to give the product 22 (374 mg, 83%):

(17β)-17,19-dimethoxyandrost-5-en-3-one, 3-cyclic 1,2-ethanediyl acetal (23): steroid 22 (374 mg, 0.72 mmol) in THF (30 mL) ) was added sodium hydride (400 mg, 60% in mineral oil, 6.0 mmol). After addition, the mixture was refluxed for 1 h, iodomethane (2.13 g, 15 mmol) was added and reflux was continued for 3 h. After allowing to cool to room temperature, water was added and the product was extracted with EtOAc (100 mL×3). The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 20% EtOAc in hexanes) to give the product 22 (402 mg, 100%):

(17β)-17,19-dimethoxyandrost-4-en-3-one (24, MQ-99): To a solution of steroid 23 (402 mg, 1.07 mmol) in THF (20 mL) at room temperature 3 N HCl (10 mL) was added. The mixture was stirred for 2 h and the product was extracted with dichloromethane (50 mL×2). The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give the product 24 (355 mg, 100%):

<Scheme 7>

(3α,17β)-17,19-dimethoxyandrost-5-en-3-ol (25, MQ-101) and (3β,17β)-17,19-dimethoxyandrost-5-en-3 -All (26, MQ-100). To a solution of steroid 24 (355 mg, 1.07 mmol) in acetic anhydride (10 mL) at 0° C. was added sodium iodide (600 mg, 4 mmol) and TMSCl (435 mg, 4 mmol). After addition, the mixture was allowed to warm to room temperature for 1 h. Thin layer chromatography showed no residual starting material. Aqueous NaHCO ₃ was added and the product was extracted with EtOAc (50 mL×3). The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was dissolved in ethanol (20 mL) and NaBH ₄ (200 mg) was added. After 16 h, aqueous NH ₄ Cl was added and the product was extracted with EtOAc (50 mL×3). The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 30% EtOAc in hexanes) to give product 25 (30 mg, 8%), and product 26 (248 mg, 69%).

Product 25 was as follows:

Product 26 was as follows:

<Scheme 8>

(3α,5α)-3-[[(dimethylethyl)dimethylsilyl]oxy]-19-methoxyandrostan-17one (27). To a solution of steroid 11 (150 mg, 0.47 mmol) in DMF (5 ml) at room temperature was added tert-butyldimethylsilyl chloride (150 mg, 1.0 mmol) and imidazole (132 mg, 2.0 mmol). After 16 h, water was added and the product was extracted with EtOAc (50 mL×2). The combined organic layers _{were dried over MgSO 4} , filtered and removed. The residue was purified by flash column chromatography (silica gel eluted with 10% EtOAc in hexanes) to give the product 27 as an oil (198 mg, 99%):

(3α,5α)-3-[[(dimethylethyl)dimethylsilyl]oxy]-19-methoxyandrostan-17-one, oxime (28): steroid 27 (195 mg, 0.45 mmol) in pyridine (10 mL) ) was added hydroxylamine hydrochloride (140 mg, 2.0 mmol) at room temperature. After 14 h, water was added and the product was extracted with EtOAc (50 mL×2). The combined organic layers _{were dried over MgSO 4} , filtered and removed. The residue was purified by flash column chromatography (silica gel eluted with 20% EtOAc in hexanes) to give the product 28 as an oil (202 mg, 100%):

(3α,5α,17β)-19-methoxy-17-nitroandrostan-3-ol (29, MQ-97): in a solution of NBS (231 mg, 1.3 mmol) in dioxane (4 mL) at room temperature Aqueous KHCO ₃ (260 mg, 2.6 mmol, 4 mL) was added. The mixture was stirred at room temperature for 30 min, then oxime (202 mg, 0.45 mmol) in dioxane (10 ml) was added. The reaction was stirred in an open flask at room temperature for 14 h. NaBH ₄ was added in 5 portions (200 mg) and the reaction stirred at room temperature for 3 hours. 6 N HCl (10 ml) was added slowly and stirring was continued at room temperature for 1 h. The product was extracted with dichloromethane (50 mL×2). The combined organic layers _{were dried over MgSO 4} , filtered and removed. The residue was purified by flash column chromatography (silica gel eluted with 30% EtOAc in hexanes) to give the product 29 (79 mg, 50%):

<Scheme 9>

(3α,5β)-3-hydroxy-19-methoxyandrostan-17-one (30, MQ-94). To a solution of steroid 10 (295 mg, 0.93 mmol) in THF (20 mL) at -40°C was added lithium aluminum tri-tert-butoxide hydride (2.0 mmol, 1.0 M in THF, 2.0 mL). After 2 h, the mixture was quenched with 3 N HCl at −40° C. and the reaction was allowed to warm to room temperature for 1 h. The product was extracted with dichloromethane (100 mL×2) and washed with brine. The combined organic extracts _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 30% EtOAc in hexanes) to give the product 30 (239 mg, 81%):

<Scheme 10>

(3β,5α,17β)-17,19-dimethoxyandrostan-3-ol (31, MQ-96). To a solution of steroid 7 (65 mg, 0.20 mmol) in THF (10 mL) at -40°C was added lithium aluminum tri-tert-butoxide hydride (1.0 mmol, 1.0 M in THF, 1.0 mL). After 2 h, the mixture was quenched with 3 N HCl at −40° C. and the reaction was allowed to warm to room temperature for 1 h. The product was extracted with dichloromethane (50 mL×2) and washed with brine. The combined organic layers _{were dried over MgSO 4} , filtered and concentrated. The residue was purified by flash column chromatography (silica gel eluted with 25% EtOAc in hexanes) to give the product 31 (55 mg, 85%):

B. [ ³⁵ S]- TBPS replacement

_{IC 50} values for non-competitive substitutes of ^{[ 35} S]-TBPS from the picrotoxin binding site on the GABA _A receptor are reported in Table 1 below.

<Table 1>

^{Inhibition of [ 35} S]-TBPS binding by Example compounds ^a

^a Results presented are from duplicate experiments performed in triplicate. The margin of error was calculated as the standard error of the mean. The methods used are known in the art (Jiang, X., et al., Neurosteroid analogues. 9. Conformationally constrained pregnanes: structure-activity studies of 13,24-cyclo-18,21-dinorcholane analogues of the GABA modulatory and anesthetic steroids (3α,5α)- and (3α,5α)-3-hydroxypregnan-20-one. J. Med. Chem., 46: 5334-48 (2003); incorporated herein by reference in its entirety).

C. Electrophysiology Results

For compounds of the present disclosure, the ability to potentiate chloride current mediated by 2 μM GABA _{in rat α 1} β ₂ γ _2L type GABA _{A receptors expressed in Xenopus laevis oocytes was evaluated and} , the results are presented in Table 2 below.

<Table 2> _{Regulation of rat α 1} β ₂ γ _2L GABA _A receptor function by Example compounds

^a The GABA concentration used for the control reaction is 2 μM. Each compound was evaluated on at least four different oocytes at the indicated concentrations, and the reported results are the ratios of currents measured in the presence/absence of added compound. Gating represents the direct current gated by 10 μM compound in the absence of GABA, and this current is reported as the ratio of compound alone current/2 μM GABA current. The margin of error was calculated as the standard error of the mean (N≧4). The methods used are known in the art (see Jiang, X., et al.).

D. Loss of tadpole orientation and swimming

Table 3 discloses the anesthetic effects of the compounds of the present disclosure. In particular, the anesthetic effect of the compounds of the present disclosure on loss of stereotactic reflex (LRR) and loss of swimming reflex (LSR).

Table 3 Effect of Examples on Tadpole Orientation and Swimming Reflex ^a

The methods used are known in the art (see Jiang, X., et al.). The margin of error was calculated as the standard error of the mean (N=10 or more animals at each of at least 5 different concentrations).

E. Loss of the rat stereotactic reflex

Plasma pharmacokinetics and qualitative evaluation of sedation were obtained in male Sprague Dawley rats according to the following procedure. Rats were dosed at doses ranging from 5 to 15 mg/kg in an appropriate vehicle by intravenous bolus administration (60 seconds) via the dorsal vein. To assess sedation, rats were gently hand held in the lateral position during dose administration. If decreased muscle tone was observed during dose administration, restraint was gradually reduced. If the animal did not return to the mouth, the time was recorded as the onset of loss of stereotactic reflex (LRR). If LRR did not occur during dosing, the animals were assessed at 5 minute intervals thereafter by placing them in dorsal supine position. Two consecutive sluggish or incomplete positioning within 30 s intervals were designated as loss of stereotactic reflex. After initiation of LRR, animals were evaluated every 5 minutes in the same manner. Restoration of the stereotactic reflex was defined as the ability of the rat to fully orient itself within 20 seconds of placing it in the dorsal supine position. The duration of the LRR was defined as the time interval between the LRR and the recovery of the stereotactic reflex.

<Table 4> Loss of stereotactic reflex (LRR) in rats

F. Canine lateral transverse sinus loss

Plasma pharmacokinetics and qualitative evaluation of sedation were obtained in male beagle dogs according to the following procedure. Dogs were dosed at a dose of 5 mg/kg in the appropriate vehicle by intravenous bolus administration (60 seconds) via the cephalic vein. To assess sedation, the dog was gently restrained during dose administration. If decreased muscle tone, limb weakness, or head drooping was observed during dose administration, the onset of the lateral transverse fossa was recorded. If lateral recumbency did not occur during dosing, the animals were then evaluated at 5 minute intervals by placing them in lateral recumbency. Poor or incomplete orientation to the sternal position was designated as the lateral fossa. After initiation of the lateral fossa, animals were evaluated every 5 minutes in the same manner. The duration of the lateral fossa was recorded as the time interval between the onset of the lateral fossa and return to the sternal position.

<Table 5> Duration of lateral transverse fossa

general method

The compounds discussed in this disclosure were prepared as discussed throughout this disclosure and by the following methods.

Solvents were used as purchased or dried and purified by standard methodologies. The extraction solvent was _{dried over anhydrous Na 2} SO ₄ , filtered and removed on a rotary evaporator. Flash chromatography was performed using silica gel (32-63 μm) purchased from Scientific Adsorbents (Atlanta, GA). Melting points were determined on a Kofler micro hot stage and uncorrected. FT-IR spectra were recorded as films on NaCl plates. NMR spectra were recorded at 300 MHz ( ¹ H) or 74 MHz ( ¹³ C) in _{CDCl 3 at ambient temperature.} Purity was determined by TLC on 250 μm thick Uniplates™ from Analtech (Newark, Del.). All pure compounds (purity >95%) were presented as single spots on TLC. Elemental analysis was performed by MHW Laboratories (Phoenix, Arizona).

Equivalents and scope

In light of the above, it will be seen that several advantages of the present disclosure are achieved and other advantageous results obtained. As various changes could be made in the methods and composites above without departing from the scope of the present disclosure, all matter contained in the above description and set forth in the accompanying drawings is intended to be interpreted as illustrative and not in a limiting sense.

When introducing elements of the present disclosure or various versions, embodiment(s) or aspects thereof, “a”, “an”, “the” and “said” are intended to mean that one or more of the elements are present. . It is also noted that the terms “comprising”, “comprising”, “having” or “comprising” are intended to be open-ended and permit the inclusion of additional elements or steps.

Claims (20)

A compound of formula (Ia): or a pharmaceutically acceptable salt thereof.
<Formula Ia>

In the above formula:
R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO(C ₁ -C ₄ alkyl)C (O);
R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;
R ₃ is H, optionally substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, optionally substituted C ₂ -C ₄ alkynyl, or optionally substituted aryl;
R _b is optionally substituted C ₁ -C ₄ alkyl;
R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;
R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;
- - - represents an optional, additional C-C bond that creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the C 5} -H substituent is absent and ;
- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that when present, R 1} is not =O. The compound of claim 1 , wherein the R ₃ group is selected from the group consisting of H, methyl, and trifluoromethyl. 3. The compound of claim 1 or 2, wherein R ₇ is selected from the group consisting of H, methoxy, ethoxy, and an optionally substituted morpholinyl ring. 3. A compound according to claim 1 or 2, wherein R ₇ is H. 5. The compound according to any one of claims 1 to 4, wherein each occurrence of - - - between _{C 5} -C ₆ and C ₆ -C _{7 is absent and C 5} -H is in the alpha position. . 5. The compound according to any one of claims 1 to 4, wherein each occurrence of - - - between _{C 5} -C ₆ and C ₆ -C _{7 is absent and C 5} -H is in the beta position. . 7. The compound according to any one of claims 1 to 6, wherein each occurrence of - - - between _{C 16} -C _{17 is absent and R 1} is in the beta position. 8. The compound according to any one of claims 1 to 7, wherein R ₂ is =O, methoxy or H. 9. A compound according to any one of claims 1 to 8, wherein R _b is methyl. 10. A compound according to any one of claims 1 to 9, wherein R ₁ is beta-methoxy. 10. A compound according to any one of claims 1 to 9, wherein R ₁ is beta-spirooxirane. 10. A compound according to any one of claims 1 to 9, wherein R ₁ is beta-cyano. 10. The compound according to any one of claims 1 to 9, wherein R ₁ is =O. 10. A compound according to any one of claims 1 to 9, wherein R ₁ is beta-nitro. 10. A compound according to any one of claims 1 to 9, wherein R ₁ is beta-CH ₃ C(O)-. 10. A compound according to any one of claims 1 to 9, wherein R ₁ is beta-HOCH ₂ C(O)-. A compound according to claim 1 selected from the group consisting of the following compounds and pharmaceutically acceptable salts thereof.

A pharmaceutical composition for inducing anesthesia in a subject in need thereof, comprising a therapeutically effective amount of a compound of formula (Ia): or a pharmaceutically acceptable salt thereof.
<Formula Ia>

R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO(C ₁ -C ₄ alkyl)C (O);
R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;
R ₃ is H, optionally substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, optionally substituted C ₂ -C ₄ alkynyl, or optionally substituted aryl;
R _b is optionally substituted C ₁ -C ₄ alkyl;
R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;
R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;
- - - represents an optional, additional C-C bond that creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the C 5} -H substituent is absent and ;
- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that when present, R 1} is not =O. A pharmaceutical composition for the treatment of a disorder associated with GABA function in a subject in need thereof, comprising a therapeutically effective amount of a compound of formula Ia: or a pharmaceutically acceptable salt thereof.
<Formula Ia>

R ₁ is (C ₁ -C ₄ alkyl)-O, spirooxirane, cyano, =O, nitro, (C ₁ -C ₄ alkyl)C(O), and HO(C ₁ -C ₄ alkyl)C (O);
R ₂ is =O, H, or OR _a , wherein R _a is selected from H, optionally substituted C ₁ -C ₄ alkyl, or optionally substituted aryl, with the proviso that when R ₂ is =O, R ₈ does not exist;
R ₃ is H, optionally substituted C ₁ -C ₄ alkyl, optionally substituted C ₂ -C ₄ alkenyl, optionally substituted C ₂ -C ₄ alkynyl, or optionally substituted aryl;
R _b is optionally substituted C ₁ -C ₄ alkyl;
R ₇ is H, optionally substituted C ₁ -C ₄ alkoxy, or an optionally substituted morpholinyl ring;
R ₈ , when present, is H or optionally substituted C ₁ -C ₄ alkyl;
- - - represents an optional, additional C-C bond that creates a C=C bond _{between C 4} -C ₅ or C ₅ -C _{6 , provided that, if present, the C 5} -H substituent is absent and ;
- - - represents an optional, further C-C bond creating a C=C bond between _{C 16} -C _{17 with the proviso that when present, R 1} is not =O. 20. The pharmaceutical composition of claim 19, wherein said disorder is selected from the group consisting of insomnia, mood disorders, convulsive disorders, anxiety, and ethanol withdrawal symptoms.